Qui Tam Whistleblowers Receive More than $4 Million for Reporting Medical Billing Fraud

An old axiom says that doing good is its own reward. In many ways, that can be true. Knowing that you’ve corrected something that was harming people can be incredibly satisfying, even if you don’t receive any other type of reward. The good feeling can be amplified if the action you take ends up helping people who require extra help because they are elderly or suffering from a serious medical condition. However, if you identify a fraud involving the misappropriation of government funds, you could receive substantial monetary compensation in addition to the feeling that you’ve done a good deed. 

Whistleblower employees at The Grand Health Care System, and its affiliated skilled nursing facilities, learned how valuable reporting misconduct can be. They were awarded approximately $4,047,000 from a settlement secured by the Department of Justice in a case generated because they exposed fraud committed by their employer. Former rehabilitation therapy providers Stacey Rosenberger and Kelley Retig filed a qui tam lawsuit that resulted in a $21.3 million settlement to resolve allegations of fraudulent billing. 

Qui tam cases are authorized by the False Claims Act as a means of combating fraud against the government. Here, Rosenberger and Retig brought suit on behalf of the United States alleging that The Grand Health System knowingly submitted false claims for rehabilitation therapy services that were unnecessary, unskilled, shorter than stated or simply did not occur. Government healthcare systems such as Medicare Part A and Tricare (which serves members of the armed forces and their families) reimburse providers for the number of minutes the patient received skilled rehab therapy. 

Healthcare providers must be aware that billing for services that are not medically necessary or accurately documented can lead to severe consequences. It also underscores the critical role of whistleblowers in uncovering fraud and abuse within the healthcare industry.

If you suspect fraud or abuse in the healthcare industry, you may be eligible to file a qui tam lawsuit, and possibly receive the same type of payment as the therapists in this case. Consulting with an experienced whistleblower attorney at Kardell Law Group can help you understand your rights and options.