Whistleblowers don’t have to suffer a bite from a radioactive spider to detect and report fraudsters. Two home healthcare companies in two different states recently settled with both the Department of Justice and those states for submitting false claims to state Medicaid programs. Academy Health Care Services of Dayton, Ohio settled with the Department of Justice for $500,000, and Home Care VNA of Chicopee, Massachusetts settled with the Commonwealth of Massachusetts for $630,000 at the beginning of 2022. Under the federal False Claims Act, a whistleblower is entitled to receive 15-25% of the government’s recovery. Under the Massachusetts False Claims Act, as with the federal False Claims Act, a private individual can sue on behalf of the government and receive a percentage of the proceeds.
According to the allegations, the Ohio home health care company bilked the Ohio Medicaid program by falsely billing the state Medicaid program for services purportedly provided in individual settings, thus garnering a higher reimbursement, when the services were actually provided in group settings. The service providers did not spend the requisite time with patients which would qualify for the higher reimbursement, as well. For receiving reimbursement from the Ohio Medicaid program over the course of three years, the provider must pay $500,000 in fines, half of which is restitution, must cease operations by mid-2022, and cease providing services to beneficiaries of federal healthcare and the Ohio Medicaid programs.