The government recently declined to join a whistleblower lawsuit that alleged Addus Homecare Corp. and a Cigna Corp. owned healthcare provider of committing medicare fraud. The companies reportedly had been scamming the government by providing services to beneficiaries who did not need them.

The whistleblower lawsuit filed as ‘Stop Illinois Marketing Fraud LLC’s 2013 False Claims Act Suit’ was recently revealed, which described how Addus would target individuals receiving both Medicare and Medicaid benefits.

Company representatives would then convince them to sign-up for home health services that they did not qualify for or was not applicable. Cigna’s Home Physicians Management LLC would then provide the doctors that were needed to sign any necessary forms.

According to the whistleblower lawsuit, from 2008 to March 2013 Addus aggressively marketed its home healthcare program to unsuspecting beneficiaries who did not need them.

More specifically, Addus tried to convince patients to sign-up for home care services such as physical or occupational therapy, when they only needed basic care assistance like bathing.

From 2009 to 2011 Addus allegedly collected $30.16 million, $32 million, and $33.4 million per respective year in Medicare fraud.

Medicare Fraud Whistleblower Allegations

Addus allegedly accomplished government fraud by focusing on patients who were of lower income and older than 65, which qualified these individuals to receive both Medicare and Medicaid benefits and could convert these benefits to skilled service.

However, Addus favored Medicare recipients because private insurance claims would have underwent a deeper analysis. Another part of their Medicare fraud was opening wellness centers in elderly care centers, where Addus would give “health chats” and screenings that the company would allegedly use to gauge potential victims.

Addus allegedly would ask the citizens to submit confidential health information that could help the company sell its programs. Additionally Addus reportedly would order its care coordinators to prioritize selling its services over clinical services, and enticed their representatives with bonuses for each elderly individual who signed up.

When the elder’s primary care physicians would not sign-off on the skilled services, Addus would ask Home Physicians Management for assistance. Despite the smooth operation, the scheme was eventually exposed when a whistleblower cried Medicare fraud.

The Medicare fraud whistleblower was a former account executive for Addus, who claimed that the company would certify paperwork if the beneficiary’s physician would not.

The Medicare whistleblower described her experiences working with company, as Addus committed Medicare fraud. According to the whistleblower, a representative was once criticized by her superiors, when she tried to get another physician to perform an in-home assessment of a potential beneficiary that Addus had been initially unsuccessful with.

The Medicare whistleblower worked for Addus from November 2010 to April 2012, and has brought these fraud claims to the forefront. Whistleblowers are employees or representatives who report their employers of defrauding the government.

By giving people the power to become a whistleblower, significant losses in government funding may be recovered.

The Whistleblower Lawsuit is Case No. 1:13-cv-09059, in the U.S. District Court of Northern of Illinois.