Two Companies Settle FCA Case with Five Whistleblowers Involved

A home healthcare business and affiliated company have settled claims brought about by a group of whistleblowers who alleged they submitted false claims for payment of lab and diagnostic testing services that were performed between Jan. 1, 2010 and Dec. 31, 2015.

The providers, U.S. Medical Management, LLC and VPA, P.C. of Michigan, are alleged to have received millions of dollars from the Medicare program for claims that were not reasonable for necessary for the diagnosis or treatment of an illness or injury. The claims were prosecuted under the False Claims Act and government contended that the payments received were overpayments.

The settlement is for $8.5 million. There were five separate qui tam, or whistleblower lawsuits filed in the case. However, the allegations first came to light in a complaint filed by Irfan Mahmood. Under the alternate remedy provision of the False Claims Act, the first-to-file whistleblower in this case will receive $1.53 million of the settlement amount.

The five cases were:

• United States ex rel. Irfan Mahmood v. U.S. Medical Management, LLC, et al., No. 2:10-cv-12022
• United States ex rel. Lisa R. Hines v. VPA, P.C. d/b/a Visiting Physicians Association, et al., No. 14-cv-13385;
• United States ex rel. Muhammad S. Rais, M.D. v. U.S. Medical Management, Inc., et al., No. 2:12-cv-15518
• United States ex rel. Pamela Henkels and Margaret Wisniewski v. U.S. Medical Management, LLC, et al., No. 2:14-cv-11944
• United States ex rel. Sian Ghosh v. U.S. Medical Management, LLC, et al., No. 18-10029

In whistleblower cases, the government can intervene. In this case, the government chose not to do so.

By law, healthcare providers who receive an overpayment from Medicare must return the overpayment within 60 days of its identification. Overpayments not returned within the 60-day limit become obligations to the federal government within the meaning of the False Claims Act.

Not all overpayments are due to fraud. Medicare overpayments happen because of incorrect coding, insufficient documentation, medical necessity errors, processing and administrative error.

As we wrote about last November, the federal government is conducting audits of home health services because it has found overpayments to be a significant issue.

The Health Law Offices of Anthony C. Vitale has extensive experience representing clients in audits and overpayments and we can represent your interests through all of the stages of the overpayment appeals process.  If you have any questions or concerns, feel free to contact us at 305-358-4500 or info@vitalehealthlaw.com