Whistleblower Nurse Reaps $15 Million Reward in Amedisys Fraud Settlement

The U.S. Department of Justice announced settlements with several healthcare companies accused of fraud — including a massive $150 million deal with Amedisys Inc. in which the government resolved seven lawsuits with the giant homecare provider, leading to more than $26 million in payouts to whistleblowers and a jackpot for U.S. taxpayers.

The largest whistleblower reward, more than $15 million, went to April Brown, an Alabama nurse and single mother who was fired by Amedisys after she questioned its Medicare billing practices.

The False Claims Act (FCA) penalizes fraud against the U.S. government, including programs such as Medicare. Its qui tam provision allows whistleblowers to sue on behalf of the government, and to get up to 30% of recovered funds as a reward.

• In the Amedisys cases, the Justice Department said the homecare company had misrepresented patients’ conditions in order to inflate Medicare payments — and also had violated the law by paying doctors for referring business to Amedisys. The company denied wrongdoing. Ms.Brown filed the original FCA complaint against Amedisys in 2012, and was followed by six other whistleblowers with similar qui tam claims, who will split about $11 million between them.
• In U.S. ex rel. Wells v. Baptist Health System Inc., a Florida healthcare provider agreed to pay taxpayers $2.5 million to settle claims that two neurologists in its network misdiagnosed patients with various neurological disorders, including multiple sclerosis, causing Baptist Health to bill government insurance programs for medically unnecessary services. The FCA lawsuit was filed originally by Verchetta Wells, a former Baptist Health employee who will receive $424,155 for her role as a whistleblower in the case, according to the Justice Department.
• In U.S. ex rel. Simmons v. Health Management Associates, Inc., an Oklahoma hospital group agreed to pay more than $1.4 million to settle charges that, among other things, it billed the state’s Medicaid program for unnecessary surgical procedures performed on children — and for other procedures that were never performed. The FCA case was filed originally by Sandra Simmons, a former manager for the group who was fired after raising concerns about the practices; she will receive $159,750 for acting as a whistleblower, the Justice Department said.

Tagged: False Claims Act (FCA), Fraud Types, Medicare Fraud, Stark Act, Whistleblower Laws (Federal)