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First ACA Whistleblower Claim Resolved with $6.88 Million Settlement

In the first-ever healthcare fraud lawsuit resulting from whistleblower actions under the Patient Protection and Affordable Care Act, a provider of home medical care services to medically vulnerable children has agreed to pay a settlement worth $6.8 million. As a part of the settlement, the two whistleblowers who alerted authorities to the company’s wrongdoing split a $1.1 million award.

One of the whistleblowers, Sheila McCray, was an employee for PSA Healthcare when she discovered an employee had millions of dollars in overpayments from Medicaid and Medicare. McCray noted her discovery to her employer, and in response, says she was told to do nothing and see whether federal investigators would catch the overpayments. Additionally, she was demoted, endured regular intimidation and retaliation by management, received a pay cut and was eventually terminated.

Taking action against the company

Ultimately, McCray teamed up with another former PSA employee, Yvette Odumosu, in filing a healthcare fraud whistleblower lawsuit against the company, alleging its failure to disclose and return Medicaid and Medicare overpayments, submission of claims without proper documentation under the Georgia Pediatric Program and submission of claims to various federal healthcare programs that overstated how long PSA staff provided its services.

A total of $1.4 million of the $6.88 million settlement will go to the Georgia Department of Community Health. The federal government and 16 states will share the remainder — aside from the money going to the whistleblowers.

Overbilling Medicare and Medicaid is one of the most common types of healthcare fraud issues. To learn more about conducting internal investigations surrounding these matters, consult a highly skilled Dallas attorney at Whistleblower Law for Managers.

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