On September 9, 2016, the U.S. Attorney’s Office for the Central District of California announced that on August 3, 2016, a Los Angeles nursing home and two physicians who worked at the California nursing home paid $3,563,140 to resolve civil allegations contained in a federal whistleblower lawsuit alleging that they participated in a scheme to improperly transfer patients recruited from the “Skid Row” district to a local hospital for medically unnecessary services, and then transfer the patients from the hospital to the nursing home for medically unnecessary stays.
The whistleblower was a former employee of the L.A. nursing home and had filed his federal lawsuit under the qui tam provisions of the federal False Claims Act, which allows private citizens to bring suit on behalf of the U.S. government and share in any recovery. The whistleblower received $534,471 from the settlement.
The whistleblower’s lawsuit alleged that between 2008 and 2010, the L.A. nursing home paid illegal kickbacks to a “care consortium” on Skid Row in exchange for patient referrals to the nursing home. The lawsuit alleged that a physician associated with the nursing home admitted patients from the nursing home to a local community hospital, which is now closed, and then re-admitted the patients back to the nursing home in order to extend the patients’ Medicare-covered stays at the nursing home, knowing that the patients did not require further services at either facility.
Another physician associated with the L.A. nursing home allegedly signed medical orders for non-payable services for the same patients, and the nursing home allegedly billed Medicare and Medi-Cal for medically unnecessary services provided to these patients.
In the U.S. Attorney’s Office’s announcement concerning the whistleblower lawsuit settlement, the Special Agent in Charge for the Department of Health and Human Services, Office of Inspector General (HHS-OIG), stated, “This round-robin system of moving mostly homeless and vulnerable people from the hospital to a nursing home and back, purely for profit not patient care is unacceptable. As this case illustrates, we will work diligently to investigate providers who abuse the system and take advantage of the elderly and disabled. These were medically unnecessary services which placed the ‘patients’ and federal health care systems at risk and this type of conduct will not be tolerated.”
The L.A. nursing home scheme is related to a large-scale scheme to defraud Medicare and Medi-Cal through the illegal recruitment of Skid Row residents for medically unnecessary medical procedures at area hospitals and medically unnecessary stays at nursing homes (in December 2013, a physician pleaded guilty to a tax offense related to his admission of patients, most of whom where homeless, to a local community hospital after they had been referred from a purported “care consortium”; after a short hospital stay, the physician discharged the “patients” to skilled nursing facilities, even though they did not require such care).
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
Click here to visit our website or call us toll-free in the United States at 800-295-3959 to be connected with qui tam lawyers (False Claims Act lawyers) in your U.S. state who may assist you with a False Claims Act whistleblower lawsuit.
Turn to us when you don’t know where to turn.