FALSE CLAIMS ACT FREE CASE EVALUATION: 1-800-632-1404

CareAll, a leading provider of home-based healthcare and nursing services, has agreed to pay $25 million to settle a Tennessee false claims lawsuit. The Nashville-based company was accused of defrauding Medicare and Medicaid funds by “by submitting false and upcoded home healthcare billings.” Toney Gonzales, the qui tam relator, is expected to receive about $4 million for his efforts to highlight the fraud and false claim.

Gonzales’s TN false claim attorney accused CareAll of exaggerating “the severity of patients’ conditions to increase billings and billed for services that were not medically necessary and rendered to patients who were not homebound” between 2006 and 2013. Filed in a federal court for the Middle District of Tennessee, it was jointly pursued by the relator, U.S. Attorney’s Office, and the Tennessee Bureau of Investigation.

A whopping $23.1 billion have been recovered by the Justice Department from false claim litigations filed nationwide in the last five years. About $16 billion of the recovered amount involved false billing and misappropriation of health-care funds. The office of the U.S. Attorney General has made combating health-care fraud a priority, as more than $60 billion meant for patient care is lost every year due to “fraud, waste, and abuse.”

Tennessee False Claims Lawsuit: The Incentive for Whistleblower

The justice department has put its weight behind whistleblower lawsuits seeking criminal health-care fraud recoveries. This renewed interest has led to a nationwide upsurge with over 750 false claim lawsuits filed over Medicare fraud last year. In Tennessee, the impact has been massive with whistleblower lawyers and plaintiffs feel incentivized to participate in any such financial recovery. In September, a Tennessee whistleblower won $1.8 million as reward for his role in the recovery of $5 million. Meridian Surgical Partners, the defendant was accused of “misappropriating of $100 million through false billing.”

A whistleblower initiating a Tennessee false claim lawsuit stands to gain financial incentives, such as

• reward of 15 to 25 percent of the total recovery from the defendant is awarded to the relator for his contribution in bringing to the notice the Medicare/Medicaid fraud when the state or federal authorities takes over the investigation and prosecution following his disclosure; or
• reward of up to a third of total money recovered from the defendant is awarded to the qui tam plaintiff for highlighting the Medicare/Medicaid fraud and proceeding on his own with a Tennessee false claim attorney and without state or federal participation in the prosecution; and
• a separate award by the court asking the defendant to pay for the legal expenses and fees of the attorney in addition to the money recovered.

The Ambit of Tennessee False Claims Medicare Law

Any type of fraudulent appropriation of healthcare funds, including false billing, phantom billing, misleading medical procedure, inadequate care, upcoding, double billing, fabrication of patient reports, and kick backs for referring, are punishable under the Tennessee Medicaid false claim act. Actions pertaining to falsification of records, conspiracy, avoidance of obligations, deliberate ignorance, and involvement in false claims with a intention to get monetary benefit also come under the legal purview of the act.

Any one, a whistleblower or a resident of the state with evidence to suggest fraud, can file a complaint with the authorities or file litigation with the aid and advice of a Tennessee false claims lawyer. However, a lawsuit claiming false claim in Tennessee must be initiated within three years of its discovery, subject to a 10-year statute of limitations.

For false claims free case evaluation and consultation with an expert Tennessee false claims attorney, please contact us or call on 1-800-632-1404.

Contact a Tennessee False Claims Act Attorney

We help whistleblowers on a contingency basis, meaning there is no fee charged for our work unless there is a recovery. We also front any and all expenses. No matter where you are located — we will represent you. We will come to you, you will not have to come to us. Attorneys in our firm and attorneys that we work with on Whistleblower, Qui Tam, False Claims Act cases have represented a host of persons making claims, for violations of federal tax law, Medicare law and more. For more information, please contact our team of whitsleblower and qui tam attorneys today.

FALSE CLAIMS ACT FREE CASE EVALUATION: 1-800-632-1404

Two separate Tennessee false claim lawsuits filed last month have accused a Memphis dermatologist, health insurance firm CIGNA, and medical billing major Zotec of defrauding Medicare funds. The Tennessee Medicaid False Claims Act of 1993 provides incentives and procedures for qui tam plaintiffs and whistleblowers to expose individuals and organizations embezzling healthcare funds and recovering the tax payers’ money misappropriated.

Dr. George Woodbury, a Memphis dermatologist running Rheumatology & Dermatology Associates, has been accused of presenting fake bills showing higher amounts between January 2008 and December 2011. The doctor “presented a large volume of claims to Medicare for adjacent tissue transfers or grafts that were either not supported by documentation or medically unnecessary,” according to the TN false claim attorney representing the qui tam plaintiff

Woodbury also submitted forged false for carrying out “other medical procedures” and even sought reimbursement for “unnecessary office visits.” The false claim lawsuit, which seeks recovery, penalties, and damages, has now been joined by the US attorney office.

The second whistleblower claim targets medical billing major Zotec Partners and CIGNA, a well-known name in health insurance sector. Filed in Davidson County Circuit Court by a former business intelligence analyst at the insurance company, the Tennessee false claim lawsuit alleges “manipulative process by CIGNA that has resulted in artificially increase in the risk for members and inflated premium prices.” The firm increased “premiums through incentives, strategic claims acceptance and by leveraging weaknesses in the ICD-9 coding system” and passed “expensive procedures onto the consumer,” insists the TN whistleblower lawyer hired by the plaintiff.

Zotec Partners is accused of supporting CIGNA in submitting upcoded bills. The whistleblower had worked at the billing company prior to joining the insurance giant.

“Together, CIGNA’s and Zotec Partners’ unscrupulous methods have made disputing medical bills enormously complex and convoluted with the intent of placing an undue burden on CIGNA members, resulting in tremendous unfair damages,” the TN false claim lawsuit maintains.

Tennessee False Claim Lawsuit: Explaining the Basics

• Who Can File

 

The state false claim act enables any Tennessee resident with adequate evidence and information about defrauding of taxpayers’ money to file false claim lawsuit. Even outsiders working in a state can become whistleblowers and benefit and protection under the state law. However, such litigations must be brought within three year of its discovery.

• The Coverage

 

The state False Claim Act covers all types of practices that result in misappropriation of public money or losses to federal, state, or local governments occurred in Tennessee. In 1993, a separate false claim law related to healthcare fund misappropriation was enacted to curb the increasing number of Medicare fraud.

• How To File

 

Filing a whistleblower lawsuit involves complex legal process and it is advisable to consult a TN false claim attorney. He will evaluate the claim and prepare a credible presentation based on your information. It is filed “under seal” at the court or with the offices or regulators empowered to investigate such cases. The state agencies may interview the whistleblower to ascertain his credibility and your lawyer is help to prepare for this. Based on the findings, the state may or may not join the prosecution initiated by you. However, plaintiffs can be party to such litigations and fight it without state assistance.

• State Joining Prosecution

 

Federal and state governments may or may not be party to the case. This also does not impact the plaintiff’s allegations. He can pursue it with his own TN whistleblower lawyer and recover defrauded money on behalf of the people.

• Recovery and Damages

 

A successful Tennessee false claim lawsuit recovers up to three-fold of the money defrauded. According to the 2013 amendments, the court is allowed to impose a hefty penalty on the defendant, who is also required to pay up to $25,000 in fine.

• Whistleblower Compensation and Security

 

A Tennessee false claim lawsuit provides for a reward ranging from 15 to 33 percent of the recovered amount for the whistleblower. It remains between 15 and 25 percent when the state joins the prosecution. The compensation goes up to a third of the total amount settled for, if the plaintiff proceeds without state support.

For false claims free case evaluation, please contact us or call on 1-800-632-1404.

Contact a Tennessee False Claims Act Attorney

We help whistleblowers on a contingency basis, meaning there is no fee charged for our work unless there is a recovery. We also front any and all expenses. No matter where you are located — we will represent you. We will come to you, you will not have to come to us. Attorneys in our firm and attorneys that we work with on Whistleblower, Qui Tam, False Claims Act cases have represented a host of persons making claims, for violations of federal tax law, Medicare law and more. For more information, please contact our team of whitsleblower and qui tam attorneys today.