August 20, 2020 – MJHS Hospice and Palliative Care, Inc. (“MJHS Hospice”) has agreed to pay $5.225 million under the False Claims Act (“FCA”) to settle a whistleblower case brought by a former nurse employee, Ellyn D. Ward, who alleged that MJHS Hospice (1) violated the False Claims Act (“FCA”) by, among other things, presenting claims to Medicare and Medicaid for hospice services at medically unnecessary levels of care; and (2) retaliated against her for protesting these practices by taking adverse employment actions.
Ms. Ward’s “qui tam” (whistleblower) lawsuit against MJHS Hospice was filed in 2014 in federal district court in Brooklyn. Ms. Ward was represented by Kaiser Law Firm, PLLC and Kaiser Saurborn & Mair, P.C.
“Ms. Ward’s deep moral integrity and respect for the rule of law compelled her to bring this lawsuit, at great personal cost, because she could not stay silent in the face of what she knew were improper billing practices at MJHS,” said Geoffrey R. Kaiser, a whistleblower attorney and Principal of Kaiser Law Firm, PLLC. “We are pleased that this matter has been concluded successfully and that substantial insurance proceeds that were wrongfully taken from the Medicare and Medicaid programs have been recovered for taxpayers.”
Under the Medicare and Medicaid programs, a hospice provider may seek payment for several levels of care, including heightened levels known as “CHC” (continuous home care services) and “GIP” (general inpatient services). To receive reimbursement for CHC, a hospice provider must show that a patient is experiencing acute medical symptoms, and to receive reimbursement for GIP, a patient must need pain control, or acute or chronic symptom management, which must be managed in a hospital.
The government’s investigation determined that MJHS Hospice: (a) from January 1, 2011 to December 31, 2015, submitted or caused to be submitted to Medicare claims for the CHC level of care for patients who did not qualify for this heightened level of care; (b) from January 1, 2012 to December 31, 2012, submitted or caused to be submitted to Medicare claims for the GIP level of care
for patients who did not qualify for this heightened level of care; and (c) from January 1, 2011 to December 31, 2015, submitted or caused to be submitted false claims to the New York Medicaid Program for the CHC level of care for patients who did not qualify for this heightened level of care.
$4,850,000 of the settlement amount will be paid to the United States for Medicare-related conduct and the federal portion of Medicaid-related conduct. $375,000 will be paid to New York State for the state portion of Medicaid-related conduct covered under the settlement agreement.
The federal False Claims Act and similar state laws offer whistleblowers (frequently called “Relators”) protections and rewards to encourage them to file qui tam lawsuits against individuals and entities that are stealing from the government through Medicare fraud and other types of fraud. The laws also allow whistleblowers and their counsel to independently pursue FCA claims on behalf of the government when the government declines to join a qui tam lawsuit.
Case citation: United States of America, et al., ex rel. Ellyn D. Ward vs. MJHS Hospice and Palliative Care, Inc., et al., Case No. 14-CV-4201
About Kaiser Law Firm, PLLC
Kaiser Law Firm, PLLC is a boutique law firm dedicated to providing experienced representation for whistleblowers reporting fraud against the government. Founded by Geoffrey R. Kaiser, a former federal prosecutor in both the Southern and Eastern Districts of New York, Kaiser Law Firm, PLLC has notable expertise in health care fraud and other financial fraud against the government, as well as complex fraud investigations. The firm’s Whistleblower Practice focuses on the representation of individuals and entities bringing claims under fraud and abuse laws, including federal and state False Claims Acts. www.kaiserfirm.com
About Kaiser Saurborn & Mair PC
Kaiser Saurborn & Mair, PC is a leading employee whistleblower law firm representing employees and executives across all sectors of business, finance, academia and professional firms. The firm is widely recognized for its use of dynamic and innovative litigation strategies to expand the scope of legal protections for its clients. www.ksmlaw.com
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