Sarah Mirando  |  March 9, 2016

Category: Labor & Employment

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A hospice adMedicare fraud at hospiceministrator recently pled guilty to taking part in altering patient records in order to justify excessive and unjustifiable Medicare bills.

The expensive care was neither given nor necessary, which led to a whopping $9.5 million in Medicare fraud losses for the company.

The Passages Hospice administrator, Gwen H., pled guilty in the Medicare fraud lawsuit, committing an offense against the United States. According to the plea agreement, the administrator was initially charged with 16 additional counts of Medicare fraud, as well as one count of making a false statement in a health care matter.

According to the whistleblower lawsuit (also known as a qui tam lawsuit), a Medicare audit in 2009 led the administrator and two other hospice employees to alter records. The employees changed documents to show a great deal of high-level care, known on the documentation as general inpatient care, that did not actually occur.

Nursing notes were altered to show that patients received general inpatient care that they did not actually receive.

The hospice administrator “knew that some of the nursing directors were upset about being asked to alter files, and that at least one of them made comments about ‘looking good in prison orange,’” stated the plea agreement.

The administrator “understood this comment to refer to the fact that those participating in altering the files knew that it was wrong to do so and that they were trying to deceive an auditor.”

After a group of employees’ attempted to file a qui tam lawsuit, against the company, the government began an investigation into Passages.

The hospital administrator also confessed that she and another Passages employee established a system in which employees could place patients into general inpatient care without justification, and receive a monetary bonus for their efforts.

According to the qui tam lawsuit settlement, the hospice administrator faces up to five years in prison, as well as a $250,000 fine. While the hospice administrator pled guilty, the employees she admitted helped her in committing Medicare fraud, and even establishing systems in which to commit further fraud, have not yet entered pleas.

Qui Tam Lawsuits

Whistleblowers are individuals who report the fraud and illegal activities against the government of their current or former employers. While a person considering becoming a whistleblower may be worried that they will get in trouble for their actions, the whistleblower is typically given a substantial reward – often between 15 and 30 percent of the money recovered in the subsequent whistleblower lawsuit.

Many employees choose to come forward as whistleblowers because they do not feel right about their employer’s actions. A whistleblower or qui tam lawsuit can be filed while working at the company, but can also be filed after having left the company.

If you believe you have witnessed some kind of fraud by your current or former employer, you may be able to file a whistleblower lawsuit (also known as a qui tam lawsuit) against your employer on behalf of the government.

In general, whistleblower and qui tam lawsuits are filed individually by each plaintiff and are not class actions.

Do YOU have a legal claim? Fill out the form on this page now for a free, immediate, and confidential case evaluation. The attorneys who work with Top Class Actions will contact you if you qualify to let you know if an individual qui tam lawsuit or whistleblower class action lawsuit is best for you. Hurry — statutes of limitations may apply.

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If you believe that you have witnessed fraud committed against the government, you may have a legal claim. See if you qualify to pursue compensation and join a whistleblower lawsuit investigation by submitting your information for a free case evaluation.

An attorney will contact you if you qualify to discuss the details of your potential case.

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