Whistleblower Case Against Tennessee-Based Nursing Care Company

IMG_5281 fixedBy Danielle M. Murray, J.D.

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) is investigating a Tennessee-based nursing care company. The company runs more than 200 skilled nursing homes (SNFs), assisted living facilities (ALFs), retirement living communities, home care services, and Alzheimer’s centers across the country. The nursing care company is accused of defrauding Medicare of millions of dollars for unnecessary and expensive therapy treatments from 2006 to 2011, according to the Wall Street Journal.

Click here to read the entire article from the Wall Street Journal.

Nursing Care Company Allegedly Overbilled Medicare and Tricare.

According to the federal complaint, the nursing care company is accused of encouraging its employed therapists to perform unnecessary and expensive therapy treatments that were billed to Medicare. The document mentioned specific cases of patients who allegedly didn’t need therapy or could have been harmed by it, but received it anyway.

In addition to Medicare, Tricare was also allegedly billed for high-priced nursing care performed at facilities that are affiliated with the nursing care company.

Letter on Company’s Website Defends Billing Methods.

Representatives from the nursing care company posted an open letter on its website. It calls the lawsuit an attempt by the federal government to target companies that provide rehabilitation therapy services. It also denies the allegations of fraudulent billing.

Click here to read the entire letter.

Whistleblowers Cry Foul.

Two former employees filed separate cases against the nursing care company, according to a Times Free Press article. In 2008, a former staff development coordinator working in Tennessee filed a complaint alleging Medicare fraud. In the same year, a former occupational therapist who had worked for the company in Florida, made similar complaints. The government decided to combine their lawsuits and is currently investigating. Be sure to check this blog in the future for updates to this story.

To read the Times Free Press article, click here.

More Medicare and Medicaid Audits May Be Coming to Health Professionals.

The Health Law Firm’s President and Managing Partner George F. Indest III wrote a two-part blog on the increased number of Medicare and Medicaid audits being initiated against health professionals who treat assisted living facility (ALF) and SNF residents. Most often these are audits by the Medicare Administrative Contractor (MAC), because this area of medical practice has been identified as one fraught with fraud and abuse. To learn more on the areas being targeted and how to respond to different types of audits, click here for the first blog and here for the second.

Contact Health Law Attorneys Experienced with Medicaid and Medicare Qui Tam or Whistleblower Cases.

In addition to our other experience in Medicare, Medicaid and Tricare cases, attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters.

To learn more on our experience with Medicaid and Medicare quit tam or whistleblower cases, visit our website. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Do nursing care companies need stricter oversight? Have you noticed an increase in Medicare or Medicaid audits in your practice area? Please leave any thoughtful comments below.


Burton, Thomas. “Medicare Fraud is Charged.” Wall Street Journal. (December 3, 2012). From: http://online.wsj.com/article/SB10001424127887323717004578157640024945594.html?mod=googlenews_wsj

Harrison, Kate and South, Todd. “Probe Reveals Claims of Unnecessary Therapies at Cleveland-based Life Care Centers.” Times Free Press. (December 16, 2012). From: http://www.timesfreepress.com/news/2012/dec/16/dying-patients-unneeded-therapy-life-care-center/?print

Life Care Centers of America. “Open Letter to Life Care Associates and Medical Professionals.” Life Care Centers of America. (November 30, 2012). From: http://lcca.com/openletter/

About the Author: Danielle M. Murray is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999. Copyright © 1996-2012 The Health Law Firm. All rights reserved.


Settlement Reached in WellCare False Claims Case

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

WellCare Health Plans Inc.(WellCare) has reached a settlement in its False Claims Act case. WellCare will pay $137.5 million to the federal government and nine states to settle four lawsuits. The lawsuits alleged violations of the False Claims Act.

WellCare is based in Tampa, Florida. The company provides managed health care services for approximately 2.6 million Medicare and Medicaid beneficiaries across the United States.

WellCare Allegedly Submitted False Claims to Medicare and Medicaid Programs.

The lawsuits accused WellCare of submitting false claims to Medicare and Medicaid programs. WellCare allegedly falsely inflated the amount it claimed to be spending on medical care. Allegedly, this was done in order to avoid returning money to Medicaid and other programs in various states, including the Florida Medicaid program and Florida Healthy Kids program. WellCare also allegedly knowingly retained overpayments it had received from Florida Medicaid for infant care. Furthermore, WellCare allegedly falsified data that misrepresented the medical conditions of patients and the treatments they received.

Settlement Requires WellCare to Pay the United States and Nine Individual States.

WellCare’s settlement requires the company to pay the United States and nine individual states $137.5 million. The nine states are Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Missouri, New York, and Ohio. The settlement also requires WellCare to pay an additional $35 million if the company is sold or experiences a change in control within three years of the agreement.

Whistleblowers Will Also Share in Settlement.

The four lawsuits against WellCare were filed by whistleblowers under the qui tam provisions of the False Claims Act. The qui tam provisions allow individuals to file lawsuits on behalf of the United States and share in any recovery.

The whistleblower whose qui tam complaint initiated the government’s investigation will receive approximately $20.75 million. The other whistleblowers will share approximately $4.66 million and will also be entitled to receive an additional share of any contingency payment.

Contact Health Law Attorneys Experienced in False Claims Act Cases.

The Health Law Firm represents physicians, medical practices, pharmacists, pharmacies, and other health provider in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving government health programs (Medicare, Medicaid, TRICARE). The Health Law Firm also represents health providers in False Claims Act cases.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources Include:

Kutscher, Beth. “WellCare Agrees to Pay Over $137.5 Million in Settlement.” Modern Healthcare. (Apr. 3, 2012). From: http://www.modernhealthcare.com/article/20120403/NEWS/304039975#ixzz1yAklA7ru?trk=tynt

U.S. Department of Justice, Office of Public Affairs. “Florida-Based WellCcare Health Plans Agrees to Pay $137.5 Million to Resolve False Claims Act Allegations.” U.S. Department of Justice. (Apr. 3, 2012). From: http://www.justice.gov/opa/pr/2012/April/12-civ-425.html

Voreacos, David. “WellCare to Pay $137.5 Million to Settle False Claims Case.” Bloomberg News. (Apr. 3, 2012). From: http://www.bloomberg.com/news/2012-04-03/wellcare-to-pay-137-5-million-to-settle-false-claims-case-1-.html

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.