Monthly Archives: July 2013

Whistleblowers Should be Revered for Courage, Not Vulnerable to Retaliation

Whistleblowers have again made national news recently. This time, however, their treatment has left many wondering if they are properly shielded from harassment, threats and retaliation. This is a travesty, because blowing the whistle is a way for individuals within a company, agency, organization or community to hold people accountable for illegalities, abuses of power and threats to public safety.

We’ve seen it in both the private sector and the public sector – the CEO of a bank or a pharmaceutical company receiving a golden parachute with retirement benefits that allows them to live the rest of their days in lavish comfort, despite a whistleblower case that points to them being involved in some form of fraud. Or the head of a government agency that is given a high-paying job in the private sector, despite a whistleblower case showing the official turned a blind eye to fraud committed in the very same private sector they now work in. So what does the whistleblower get? While it’s true that whistleblowers can receive substantial rewards in qui tam cases, they can also be bullied, harassed and threatened. It’s time for this to stop.  

The teenage children of Aurelia Fedenisn answered the door to their suburban Washington, D.C. home to find two diplomatic security agents standing in the doorway. Fedenisn, a former investigator for the State Department’s Inspector General, had recently disclosed to a U.S. Senator that her office was forced to cover up allegations of high-level State Department officials using drugs and soliciting prostitutes.

According to an article in USA Today, the two men verbally threatened Fedenisn’s children, demanding to speak to the former investigator. Additionally, Inspector General staff initiated a stake out on her front yard in an attempt to bully her into admitting that she had done something wrong.

This type of retaliation is nothing new, as many whistleblowers, like Jeff Black, have found out the hard way. P. Jeffrey Black was an Air Marshal that spoke out against the Department of Homeland Security and the U.S. Air Marshal Service. During his tenure, he testified before Congress, complaining about agency shortcomings. His bosses accused Black of leaking reports of budget cutbacks. Black told CNN that his actions resulted in a demotion to a menial desk job and his home being placed under surveillance.

After he retired, Black appeared in a documentary critical of U.S. airline security measures, entitled, “Please Remove Your Shoes.” On the same day the documentary premiered, an agent from the Internal Revenue Service (IRS) showed up at his door. Black endured a yearlong audit that saw a lien placed on his home. Oddly enough, the audit found that the government actually owed him more money than he owed the government – thousands more. Black paid what he owed. Did he ever receive any of the money owed to him? Nope. The government claimed the statute of limitations had run out.

Whistleblowers should be lauded for their courage and protected from persecution rather than being vulnerable to threats and harassment.

Nursing Homes and Fraud (continued)

In our last blog, we discussed how nursing homes commit fraud by billing  Medicare and/or Medicaid for services that are either not necessary or that they simply didn’t provide. This is one of the most common ways nursing homes cheat government health care agencies, and the blowback for taxpayers and for patients is substantial to say the least.

RehabCare, Inc.

In 2009, a report issued by the Department of Health and Human Services showed that the U.S. government paid nursing facilities roughly $5.1 billion for patient stays in nursing home facilities that did not meet quality of care requirements. Think about that – Medicare paid nursing home facilities over five billion dollars for substandard care.

Unfortunately, billing for substandard care (or no care at all) isn’t the only scheme that unethical nursing facilities use to commit fraud. Medical device companies, pharmaceutical companies and ambulance companies, for example, all look at nursing homes as a potential wellspring of business. To get that business, some providers pay kickbacks or bribes to nursing homes in order to secure contracts. These bribes can come in the form of gifts, expensive all paid vacations, or in veiled payments made in the form of speaking or consulting fees.

In 2011, the FBI arrested 47-year-old nursing home administrator Kelvin Washington for “accepting payments for the referral of dialysis patients to a Houston ambulance transport service.” Washington allegedly pocketed $20,000 in a scheme designed to send nursing home patients to the ambulance transport service. According to the indictment, Medicare and Medicaid were billed an estimated $1 million in false claims due to the alleged fraud. Washington is currently serving a two-year prison sentence and has been ordered to pay $480,000 in restitution to Medicare and Medicaid.

The U.S. Department of Justice joined another lawsuit last year involving kickbacks that were allegedly paid to a nursing home in Missouri from a rehabilitation center. RehabCare Group, Inc. allegedly brokered a revenue-sharing deal with Health Systems, Inc. in which RehabCare paid the nursing home company to refer patients. According to the complaint, RehabCare has allegedly received over $70 million in revenue since the deal between the two companies was constructed in 2006.

Lost in all of this are the patients who have no control over the quality of care they receive. Companies that cynically put profit over people need to be held accountable.  If you work in a nursing home and have firsthand knowledge of billing for services that are either substandard or nonexistent, or kickbacks being paid in exchange for nursing home patient referrals, consider contacting Baum, Hedlund, Aristei & Goldman. You need to know that you have rights and protections provided by law, especially if you have been terminated for objecting to these improper schemes.

Nursing Homes at the Center of Medicare Fraud and Abuse

The decision to place a loved one in a nursing home is a difficult one that thousands of American families face every year. Elderly patients in nursing facilities and in assisted living programs are some of the country’s most vulnerable population. We all want to believe that these nursing homes are giving elderly patients the care and attention they deserve. The sad truth is that some for-profit nursing home facilities take advantage of this elderly patient population by engaging in fraud schemes which undermine the care they are supposed to receive and cheat the government out of millions of dollars every year.

nursing home

Government health care programs – primarily Medicare and Medicaid – pay nursing homes millions of dollars each year to provide adequate care to their patient populations. Unfortunately, some nursing companies divert patient care money to pay themselves huge salaries and perks and increase company profits.  This is at the expense of both the patients in these nursing facilities and the American taxpayer. In 2009, for example, nursing homes fraudulently billed $1.5 billion in improper charges.

In addition to demonstrating a shocking lack of ethics and compassion, these companies bilk money from government health care programs in a variety of ways including overcharging for services that are either not needed or not provided. Government health care agencies like Medicare operate a system that, in large measure, depends on health care providers to bill honestly. This opens the door for those dishonest providers that are more interested in profit than integrity.

In a recent CBS News report, Helen Toomey, a former assistant manager and speech therapist at a Life Care Centers of America (the third largest nursing home chain in the U.S.) in Plymouth, Massachusetts said, “40 percent of the work she was being told to administer was not reasonable or necessary.” At one point in 2011 shortly before leaving her job, she tried to get four patients discharged from Life Care. All four of the requests were denied, according to Toomey, because the company simply wanted to continue receiving reimbursement for those patients from Medicare. “They felt that no one was watching them and so every patient that came through the building they could charge the highest rate of reimbursement, regardless of their diagnosis or need.”

On her last day at Life Care, Toomey took some patient notes, which she then handed over to the U.S. Justice Department. According to court documents (the Justice Department is suing Life Care for Medicare fraud), Medicare paid Life Care $4.2 billion between 2006 and 2011. Of that amount, Life Care billed nearly 68 percent of its rehabilitation days at the highest possible Medicare reimbursement levels; nearly double the nationwide average.

The actions of nursing homes that commit fraud steal millions of tax dollars and hurt the very people that these health care systems were created to care for. Sadly, there are many horror stories.  One involves a 92-year-old lung cancer patient forced to endure two hours of physical therapy and speech therapy until he was spitting up blood, just so the nursing home could bill for services. Another involves a 77-year-old woman who fell three times due to short staffing, breaking her hip on two occasions and requiring several surgeries.

Nursing homes are required to have adequate nursing and support staff working each shift so that minimum levels of care can be provided. Without adequate staffing, patients are not properly bathed and cleaned, they are not turned in bed regularly resulting in potentially life threatening infections from bed sores, they don’t receive necessary exercise and rehabilitation, and perhaps most insidiously, patients that can’t feed themselves are not fed.

In our next whistleblower blog, we’ll look at other methods used by nursing home facilities to bilk money from taxpayers and government health care agencies.