False Claims Act Recovery

Whistleblower Gets $4M in False Claims Act Recovery

In Michigan, a former health information coder at Vibra Hospital of Southeastern Michigan named Sylvia Daniel will soon receive a reward of more than $4 million as a result of a recent settlement of claims that Vibra Healthcare LLC, a national national hospital chain based in Pennsylvania, violated the False Claims Act. As part of this False Claims Act recovery and settlement, they have agreed to pay $32.7 million plus interest.

According to the complaint in the whistleblower suit, Vibra Healthcare, which operates 36 long-term care hospitals and inpatient rehabilitation facilities throughout 18 states, billed Medicare for services that were deemed medically unnecessary. The initial whistleblower lawsuit was filed in the Southern District of Texas, where Vibra operates a long-term care hospital when it was discovered that the company was admitting patients who failed to demonstrate symptoms that would qualify them for long-term care or hospital-level rehabilitative services under Medicare rules.

The Department of Justice intervened in the lawsuit and alleged that between 2006 and 2013, five long-term care hospitals and one inpatient rehabilitation facility operated by Vibra were not considering medical necessity, qualification or quality of care when it came to admitting patients. As a result, those patients did not qualify for admission and extended patient stays under Medicare rules. DOJ investigators also alleged that Vibra facilities routinely ignored the recommendations of doctors that patients be cleared for discharge. All of that led to billing Medicare for services that were medically unnecessary, which is considered a serious violation of the False Claims Act (FCA), a law designed to protect taxpayers and to ensure that patients get the care they need.

In addition to the $32.7 million False Claims Act recovery, the settlement declares that all Vibra facilities will enter into a corporate integrity agreement with the U.S. Department of Health and Human Services Inspector General. In a statement, the OIG said, “Medical necessity is fundamental if health providers wish to claim taxpayer funds for medical care. OIG is committed to protecting precious Medicare dollars and ensuring that beneficiaries receive quality, necessary long term care.”

The settlement resolves claims that the Department of Justice pointed out were simply allegations and said that no determination of liability on the charges of cheating Medicare by billing for medically unnecessary services had been made. However, they did note that Sylvia Daniel would receive a whistleblower award of at least $4 million for her information assistance in getting the information regarding Vibra Healthcare’s alleged misconduct.

The purpose of the False Claims Act is to recover stolen taxpayer dollars. Since January 2009, the government has recovered more than $30 billion and more than half that amount has come from fraudulent healthcare billing. As happened in this case, a significant amount of that recovery has come thanks to whistleblower lawsuits. In those cases, the first whistleblower to file is entitled to a cash reward of as much as 30 percent of any False Claims Act recovery.

If you have knowledge of any fraudulent behavior on the part of any government contractor, or you know about Medicare or Medicaid fraud, please contact the False Claims Act Attorney atThe Hill Law Firm. We can help you stop the waste, fraud and abuse and make sure you get what you deserve.

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