A whistleblower lawsuit has been filed by two former employees of Bon Secours New York Health System over allegations that the agency demanded millions of dollars from the federal government by presenting false Medicare claims for payment.

Plaintiffs Jo Ann D. of New Jersey and Melissa O. of New York filed the qui tam lawsuit on behalf of the U.S. government and the state of New York claiming that Bon Secours intentionally violated the Federal False Claims Act and the New York False Claims Act.

According to the whistleblower lawsuit, Bon Secours knowingly and routinely submitted false claims to Medicare and Medicaid and demanded payments from the government that they were not entitled to.

The plaintiffs further allege that the certified home health agency, along with their agents and employees knew that the claims for payment were fraudulent but submitted them regardless.

Former Bon Secours nurse coordinator Jo Ann and intake coordinator Melissa claim that they repeatedly informed their supervisors that the health care agency was violating state and federal laws but allege that the defendant “continued to knowingly submit the erroneous claims.”

The plaintiffs say they witnessed Bon Secours keep patients in the home healthcare program even though they needed care that the program did not provide, in order to keep billing Medicaid.

The qui tam lawsuit also claims that Bon Secours intentionally failed to report or return any overpayments made by Medicare or Medicaid, which is a violation of the Affordable Care Act.

As part of the whistleblower lawsuit process, the plaintiffs submitted a disclosure statement summarizing the known material evidence and information related to the qui tam case to Attorney General Loretta Lynch. This statement is supported by material evidence in the defendants possession.

If Bon Secours is found in violation of the False Claims Act, they will be required to pay three times the amount of damages that the U.S. government has sustained plus a civil penalty of $5,000 to $10,000 for each violation.

If the U.S. government elects to proceed with this action, plaintiffs Jo Ann and Melissa will be awarded between 15 and 25 percent of the recovered proceeds.

If they do not proceed with action, and the company is found in violation of the False Claims Act, the plaintiffs will be awarded the amount courts deems reasonable which is between 25 and 30 percent of the recovered proceeds.

What is a Whistleblower Lawsuit?

Whistleblower or qui tam lawsuits are filed by individuals who witness and have evidence that their employer has committed government fraud. Typical whistleblower lawsuits involve employers committing health insurance fraud, Medicare fraud or government contractor fraud.

After a whistleblower lawsuit is filed, the federal government has 60 days to decide if they want to join the qui tam lawsuit. Even though having the government join a qui tam lawsuit typically makes the case more successful, plaintiffs are welcome to pursue legal action on their own if the government opts out.

Whistleblowers are protected under the False Claims Act from being fired, harassed or demoted because they filed a qui tam lawsuit.

The Whistleblower Lawsuit is Case No. 1:13-cv-08792-RMB in the U.S. District Court, Southern District of New York.