by Brian Mahany
The Inspector General for the Department of Health and Human Services released a report last week that claims nursing homes overcharge Medicare by more than $1 billion annually. In a random sample of billing claims, approximately 25% were incorrect according to the report. The largest percentage of error was tied to upcharging on therapy – in other words, billing for therapy that was not provided or provided at a lower level.
While that sounds harmless, taxpayers are left footing the bill. While many non profit nursing homes are struggling to keep their doors open, some skilled nursing facilities are run by large corporations focused more on profit than patient care.
Whether intentional or accidental, billing errors are costly. According to the survey, those errors cost taxpayers $1.5 billion in 2009.
While its rare to bill services that were not received, many nursing homes billed for much more therapy than actually received. That means a patient might receive 30 minutes of therapy but the government gets billed for 60 minutes.
While the report seeks more oversight and review, employees and former employees are often the best source of information. The three largest federal false claims actions in the nation all came from the health care industry and all were initiated by whistleblowers.
Under the federal false claims act, whistleblowers with inside information can be awarded up to 30% of what the government collects from overpayments or fraud. That means if your information leads to $1 million of overpayments paid back to Medicare, you could receive up to $300,000. The actual award figure is usually around 20% or so. Still, not a bad pay day.
To claim an award, you generally must be the first to file and have inside information about how the fraud is committed. A false claims act case is commenced when you file a lawsuit in federal court. That case remains sealed while the government investigates. Ultimately the government can advice the court whether it wants to intervene.
The rules are a bit complex but lawyers can help you by filing the suit for you. Most false claims lawyers charge on a contingent fee basis meaning they only get paid if you win.
In addition to the ability to earn a sizable award (whistleblowers have sometimes received awards in excess of $100 million!), it’s also the right thing to do. In a day when corruption is the norm and America so sorely lacks heroes, whistleblowers have become the new heroes in the war against corporate greed.
The fraud recovery lawyers at Mahany & Ertl represent the whistleblower in the largest false claims act case currently pending in the Unites States. A massive $2.4 billion case in Manhattan. We welcome the opportunity to help other whistleblowers earn their fair share of rewards and clean up corruption.
If you think you have a case, give us a call. All inquiries are protected by the attorney – client privilege and kept in strict confidence. For more information, contact attorney Brian Mahany at or by telephone at .
Mahany & Ertl – America’s Fraud Lawyers. Offices in Milwaukee, Wisconsin; Detroit, Michigan; Portland, Maine and Minneapolis, Minnesota. Services available in many jurisdictions.