Best Choice Home Health Care Agency Settles Kickback Case for $1.8 Million Thirteen whistleblowers in health care lawsuits filed under the federal False Claims Act are current or former employees of the defendant in the cases.
Parker Waichman notes that whistleblower lawsuits can be filed over many different types of fraud-involving goods and services-that cost the government money.
Four of the unsealed actions involve kickback allegations, according to The National Law Review. A lawsuit alleging that Best Choice Home Health Care Agency Inc. in Kansas City and its owner, Reginald B. King paid kickbacks in return for referring Medicaid patients has been settled. Best Choice will pay $1.8 million to settle the lawsuit that filed by a Best Choice employee.
Legal documents indicate that from about July 2010 to January 2013, King offered to pay the employee to refer clients to Best Choice. King would pay $50 for each client referred to Best Choice in addition to the service hour payments. King had signs placed in the Best Choice office advertising the $50 referral payment. The alleged kickback arrangement directly compensated the employee for each hour of service that Best Choice billed Medicaid.
According to the Justice Department, King paid the employee and Vision Group (a patient transport company the man started) $58,000. The employee also blew the whistle on other Best Choice employees, alleging they falsified timesheets to pad the number of hours they worked for clients. Client signatures were routinely forged. One “employee” logged up to 80 hours per week working as a transitional living specialist when in fact he had a full-time job at Time Warner Cable. Another employee charged TLS services to Medicaid for a client who was incarcerated or homeless at the time, the Kansas City NPR station KCUR reported.
The former Best choice employee collects $43,178, or 10 percent of the federal share of the settlement, minus the amount of kickbacks. And he does not face jail time. Qui tam whistleblowers typically receive anywhere from 15 to 30 percent of the total recovery in a case but that share is reduced if the whistleblower was involved in the fraud. Best Choice Home Health Care Agency Inc. is still in business.
Qui Tam Background
Qui tam, or whistleblower, laws have existed for hundreds of years. Under these laws, a private individual brings a lawsuit on behalf on the government as well as on his or her own behalf. In U.S. law, whistleblower suits trace back to the Civil War, when there was widespread military contractor fraud. Contractors supplied defective products, substituted inferior materials, and engaged in price gouging of the Union Army.
President Abraham Lincoln urged Congress enacted the Civil False Claims Act, including qui tam provisions, as a tool to fight fraud. Between 1863 and 1986 the law was seldom used. But as a result of 1986 amendments, qui tam actions increased dramatically.
The False Claims Act rewards whistleblowers with a percentage of the money that the government recovers as a result of a qui tam lawsuit. This provision encourages individuals to assist the government in reducing Medicare fraud, defense fraud, and other kinds of fraud, despite the effect whistleblowing might have on their jobs and personal lives. Under the False Claims Act, the government may recover up to three times the amount of money it lost as a result of the fraud. The whistleblower’s share is calculated based on the amount the government recovers, not the actual losses.
Qui tam actions have been effective in combating procurement and program fraud. Since 1986, qui tam recoveries have exceeded $1 billion with most of the recoveries involving fraud in defense and health care programs. A 2015 Justice Department news release says the Justice Department has recovered more than $23.9 billion through False Claims Act cases since January 2009, with more than $15.2 billion recovered in cases involving fraud against federal health care programs like Medicare. The False Claims Act is “one of the most powerful tools” in the effort to reduce such fraud, Justice Department officials say.
If the government joins the case, the whistleblower is entitled to at least 15 percent, but not more than 25 percent of what the government recovers. If the government does not join the case, the whistleblower is entitled to at least 25 percent, but not more than 30 percent of the money the government recovers.
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