© 2009 The Medical-Legal News
By Rose Clifford, editor
SouthernCare Inc., an Alabama hospice company, will pay the federal government $24.7 million to settle Medicare fraud charges under a False Claims Act (qui tam) suit. The whistleblowers, or relators, who reported SouthernCare’s fraudulent billing to the government will split $4.9 million for their role in bringing the action.
The whistleblowers were Tonja Rice and Nancy Romeo. Rice is a legal nurse consultant based in Birmingham, according to her web site.
According to Birmingham Weekly, SouthernCare was billing taxpayers for “Medicare claims for elderly patients who were not dying and not in need of hospice services.”
Rice and Romeo were former employees of SouthernCare, according to Modern Healthcare and a Department of Justice press release of Jan. 15.
Gregory G. Katsas, Assistant Attorney General of the Civil Division, said in the DOJ release, “This settlement sends a clear message that the Department of Justice will not allow healthcare providers to take advantage of beneficiaries in their attempts to game the reimbursement system.”
“Today’s settlement results from two qui tam suits filed by two former SouthernCare employees, Tanya [sic] Rice and Nancy Romeo, on behalf of the United States. The False Claims Act authorizes private parties to file suit against those who defraud the United States and to receive a share of any recovery. The United States will pay $4.9 million to the individuals who filed the actions against SouthernCare.”
“Our investigation showed a pattern and practice to falsely admit patients to hospice care who did not qualify and to bill Medicare for that care. This resulted in taxpayers bearing inappropriate costs,” said U.S. Attorney Alice H. Martin in the release.
SouthernCare did not admit any liability in the settlement, according to Modern Healthcare.
Rice, on her web site atwww.legalregisterednurse.com, says, “…I have had much experience in hospice (end of life comfort care) and I also have experience… with billing procedures….”
Nursing malpractice cases return plaintiff verdicts Next Post:
RAC audits to increase; Goal: cut Medicare costs