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Medicare whistleblowers help keep the skyrocketing costs of healthcare in the U.S. from expanding even further. Medicare is a huge federal program that has been providing medical services to the elderly in America since 1965, and unfortunately, Medicare fraud has been a problem ever since the program's inception.
For example, a recent Medicare fraud investigation concluded in a $24,700,000 fine for an Alabama-based hospice company named SouthernCare. According to the government's lawsuit, SouthernCare repeatedly enrolled patients who were not eligible in their hospice facilities, and then SouthernCare billed Medicare millions for the services provided to those individuals.
Hospice care is meant to provide palliative care for people without hope of a cure for their illness — patients with six months or less to live. Two whistleblowers filed separate suits in 2005 and 2007, alleging that over an eight-year period, SouthernCare was "mining" nursing homes, churches, and doctors' offices to find elderly patients they could dupe into being cared for at SouthernCare hospices (which were located in 15 states), even though SouthernCare managers were completely aware that these patients weren't eligible for Medicare hospice coverage.
A typical patient was a man who'd had successful heart bypass surgery; he stayed at a SouthernCare hospice for four years. As one of the whistleblower's attorneys explained, "It was a numbers game with SouthernCare…they were trying to bolster their rolls because Medicare pays for hospice care and does not [always] pay for home care."
The two whistleblowers — both registered nurses — will receive $4,900,000 from the SouthernCare Medicare fraud settlement. Such a reward for whistle blowing is part of the government's policy to help uncover fraud against it — fraud that ultimately costs American taxpayers billions of dollars. The Medicare program takes whistleblower cases very seriously.
Assistant Attorney General Gregory Katsas noted in the SouthernCare case, "This settlement sends a clear message that the Department of Justice will not allow healthcare providers to take advantage of beneficiaries in their attempts to game the reimbursement system."
There are some guidelines and requirements regarding Medicare fraud reporting. If you suspect Medicare fraud, you can report it to a Medicare fraud control unit such as the federal Attorney General's Office. It's also a good idea to talk to a Medicare fraud attorney about your concerns; he or she can give you guidance and make sure that your legal rights are protected. If you are in need of an experienced whistleblower lawyer, please contact us today and schedule a private consultation.
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