Employee Whistleblowers score a win against Medicare fraud in Ohio
OHIO – Employees turned whistleblowers have helped the government to recover millions of Medicare funds claimed fraudulently by one of the biggest nursing home operations in Ohio.
Ohio-based Foundations Health Solutions Inc. (FHS), Olympia Therapy Inc. (Olympia), and Tridia Hospice Care Inc. (Tridia), and their executives, Brian Colleran (Colleran) and Daniel Parker (Parker), have agreed to pay about $19.5 million to resolve cases alleging that they submitted false claims to Medicare, the Department of Justice announced on July 17.
As part of the settlement, FHS and Colleran have also entered into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services’ Office of Inspector General. The agreement is tailored to increase the accountability and transparency of FHS and Colleran so future fraud and abuse will be quickly spotted and avoided.
The settlement resolves allegations filed in two separate lawsuits by Vladimir Trakhter, a former Olympia employee, and Paula Bourne and La’Tasha Goodwin, former Tridia employees, in federal court in Columbus, Ohio. They filed the lawsuits under the whistleblower provisions of the False Claims Act (FCA), which permit private individuals as relators to sue on behalf of the government for false claims and to share in any recovery.
Of the $19.5 million settlement, Mr. Trahkter, a physical therapy assistant, will receive a whistleblower award approximately $2.9 million; Ms. Bourne and Ms. Goodwin will split a qui tam award of $740,000, the DOJ said.
The deal specifically resolves allegations that from January 2008 to December 2012, Olympia and PSI/BCFL made false claims to Medicare. It allegedly claimed payment for medically unnecessary rehabilitation therapy services at 18 skilled nursing facilities. The government found the provided therapy services excessive, increasing Medicare reimbursement unnecessarily.
The deal also resolves allegations that from April 2011 to December 2013, Tridia made false Medicare claims for hospice services to ineligible patients which Tridia didn’t properly certify or medically examine, the DOJ said.
Settled also in the deal are the allegations that between January 2008 and December 2012, the two executives, Colleran and Parker, sought and got payoffs for referring patients in skilled nursing facilities of PSI and BCFL to Amber Home Care LLC, a home health care services provider.
The DOJ said the deal resulted from a coordinated effort by the Civil Division’s Commercial Litigation Branch and the U.S. Attorney’s Office for the Southern District of Ohio, with assistance from HHS-OIG, the HHS Office of Counsel to the Inspector General, and the Ohio Medicaid Fraud Control Unit.
“It is unacceptable for an entity entrusted to care for our most vulnerable and elderly citizens to make decisions based on profit, not quality of care,” said U.S. Attorney Benjamin C. Glassman of the Southern District of Ohio in a statement. “Subjecting the elderly to inappropriate levels of therapy can be physically harmful, and failing to properly certify and re-certify hospice patients can have a devastating impact on the patients and their families.”
The case is filed as United States of America et al. v. Provider Services Inc. et al., case number 1:11-cv-00217, and United States of America et al. v. Colleran et al., case number 1:12-cv-00935, both in the U.S. District Court for the Southern District of Ohio. (end)