Sarah Markley  |  July 6, 2017

Category: Labor & Employment

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whistleblower healthcare fraud lawsuitA Pennsylvania healthcare company has been ordered to pay almost $54 million to settle False Claims Act allegations in a recent healthcare fraud lawsuit.

Pennsylvania-based Genesis Healthcare Inc. is one of the largest U.S. providers of skilled nursing and rehab nursing services. It has been recently been ordered to pay the federal government $53.6 million to reconcile claims that Genesis and its subsidiaries provide medically unnecessary care as well as care that was “grossly substandard.”

Law360 reports that this healthcare fraud lawsuit settlement ends several federal lawsuits surrounding Genesis and other healthcare companies it has acquired. Seven named plaintiff whistleblowers will receive close to $9.7 million of the $54 million as part of the qui tam healthcare fraud lawsuit settlement.

It was alleged that Genesis and companies that it owns, including skilled nursing facilities, assisted ­living and senior homes, and rehabilitation therapy businesses, provided care that was to a large degree substandard. Genesis then allegedly billed the government for this and other medically unnecessary services.

Critics claim that Genesis billed Medicare and Medicaid for services not rendered, unnecessary services and substandard services and did this to boost profits and increase their bottom line.

The U.S. Department of Health and Human Services’ Office of Inspector General’s Special Agent in Charge, Steven J. Ryan told Law360 in a recent statement, “We will continue to crack down on medical providers who betray the public’s trust and the needs of vulnerable patients through fraudulent billing and irresponsible practices.”

Genesis denies the allegations in this healthcare fraud lawsuit but will agree to pay the $53.6 million settlement regardless to resolve the four sets of claims that are under the umbrella of this settlement.

The first set of allegations claims that Skilled Healthcare in Las Vegas billed Medicare for patients who they say were in hospice care, yet were not terminally ill. They also allegedly inappropriately billed for physician evaluation management services.

Additionally, it was alleged in this healthcare fraud lawsuit that the companies upped patients’ Resource Utilization Group level to gain more money from the government. This means that the skilled nursing facilities claimed that the patients needed more skilled therapy than was necessary, thereby getting paid more money that was needed.

Also, the Department of Justice claims that several of Genesis’ subsidiaries in Georgia sent false claims to Medicare Part B for unskilled or unnecessary services.

The last set of allegations claims that a Genesis subsidiary tried to bill Medicare and Medi-Cal for substandard services or worthless services.

The U.S. Attorney General for the Northern District of Georgia said regarding this healthcare fraud lawsuit, “Health care providers that falsify claims for unauthorized or unnecessary services steal precious taxpayer dollars, and we will aggressively seek to recover those funds for the program that needs them.”

These Healthcare Fraud Lawsuits are Cretney­-Tsosie, et al. v. Creekside Hospice II LLC, case number 2:13­-cv-­00167, in the U.S. District Court for the District of Nevada; McAree v. SunDance Rehabilitation Corp., case number 1:12-­cv-­04244, in the U.S. District Court for the Northern District of Georgia; West v. Skilled Healthcare Group Inc. et al., case number 3:11-­cv-­02658, in the U.S. District Court for the Northern District of California; Deaton v. Skilled Healthcare Group Inc. et al., case number 4:14-­cv-­00219, in the U.S. District Court for the Western District of Missouri; and Wilson v. Skilled Healthcare Group Inc. et al., case number 4:14­-cv-­00860, also in the U.S. District Court for the Western District of Missouri.

A whistleblower lawsuit that succeeds in recovering money for the government will also provide a reward for the claimant. In cases where the government intervenes, the claimant usually gets between 15 and 25 percent of the amount recovered, plus legal fees and other expenses related to the action.

Though each case is unique, the prospect of an award for the claimant plus whistleblower protection can make filing a whistleblower lawsuit worthwhile. One study published in the Boston University Law Journal weighed the pros and cons of being a whistleblower and concluded that in many cases the reward a claimant stands to gain outweighs disincentives like the risk of whistleblower retaliation.

In general, whistleblower and qui tam lawsuits are filed individually by each plaintiff and are not class actions. Whistleblowers can only join this investigation if they are reporting fraud against the government, meaning that the government must be the victim, and that the alleged fraud should be a substantial loss of money.

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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Join a Free Whistleblower, Qui Tam Lawsuit Investigation

If you believe that you have witnessed fraud committed against the government, you may have a legal claim. Whistleblowers can only join this investigation if they are reporting fraud against the government, meaning that the government must be the victim, and that the alleged fraud should be a substantial loss of money.

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.

Please Note: If you want to participate in this investigation, it is imperative that you reply to the law firm if they call or email you. Failing to do so may result in you not getting signed up as a client, if you qualify, or getting you dropped as a client.

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Please note: Top Class Actions is not a settlement administrator or law firm. Top Class Actions is a legal news source that reports on class action lawsuits, class action settlements, drug injury lawsuits and product liability lawsuits. Top Class Actions does not process claims and we cannot advise you on the status of any class action settlement claim. You must contact the settlement administrator or your attorney for any updates regarding your claim status, claim form or questions about when payments are expected to be mailed out.