NC Public Safety Official Files Whistleblower Lawsuit after being Fired

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A man who was fired from his job as a state prison health-care employee has filed a whistleblower lawsuit against the N.C. Department of Public Safety and its former deputy secretary, News Observer reports. The suit was filed on Wednesday in Wake County Superior Court. The man filing the suit was deputy secretary and general counsel until March.

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VA Whistleblower Says She was Penalized for Refusing to Cook Books

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The whistleblower who prompted a federal investigation of the Fort Collins Veterans Affairs clinic says that she was punished for refusing to lie and cheat the system when scheduling appointments. According to the Fort Collins Veterans Affairs clinic, she was placed on two-week unpaid leave for refusing to “cook the books”.

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Blue Cross Blue Shield ND Faces Whistleblower Lawsuit Filed by Ex-Medical Director

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A former medical director at Blue Cross Blue Shield of North Dakota filed a whistleblower lawsuit against the company on Tuesday, WDay 6 News reports. Dr. Kenneth Fischer alleges that he was fired from the company after speaking out about illegal insurance practices that may cost customers millions in higher premiums and out-of-pocket costs. The suit was filed in Cass County District Court.

Dr. Fischer, who was the director of behavioral health for Noridian Mutual Insurance Co. doing business as Blue Cross Blue Shield North Dakota, alleges in his lawsuit that the company gave some members more benefits than others despite being on the same plan. The suit alleges that Blue Cross Blue Shield ND used employer accounts to overpay provides and subsequently failed to recover the overpayments. The company had no legal basis for these actions and did not make any effort to recover the money, the lawsuit alleges.

The whistleblower suit alleges that Fischer discovered what he believed to be faulty practices in his behavioral health area, but then realized that it was a “significant and widespread” problem in the company, “later determined to infect the entire book of business of BCBSND.”

According to WDay6 News, Fischer’s lawsuit alleges that he approached Jacquelyn Walsh, vice president of clinical excellence and quality, about these practices in 2012 but these concerns were followed by months of inaction. Allegedly, he had a meeting with Walsh last November in which he disclosed the illegal insurance practices he discovered. Among other things, he said that “Thousands of claims had been wrongly paid that were previously denied by a medical director, and sometimes reviewers and appeals reviewers.” He also accused the company of a decade-long culture of “workarounds” was in place that skipped behavioral health analyses and claims. In another meeting, Fischer informed the compliance office that the company was violating both the Employee Retirement Income Security Act and the Federal Employees Benefit Health Plan, the lawsuit says.

The suit also claims that the alleged violations may lead to repayments to employer groups and millions of dollars in penalties.

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Muscle Maker Grill Faces New Whistleblower Lawsuit

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There are at least two whistleblower lawsuits filed against one of the largest owners of Muscle Maker Grill franchise restaurants. MyCentralJersey.com reports that the suits were filed by former managers. On Monday, a spokeswoman for the Labor Department confirmed the federal investigation, which is being conducted by the department’s Wage and Hour Division offices located in North and South Jersey.

The lawsuits name Johns Marques, a Linden resident who owns and operates several eateries. It is alleged that he fired a manager for speaking with a federal labor investigator. According to published reports, he owns at least a dozen locations in New Jersey.

The founder and chairman distanced themselves from the litigation

Last summer, Home News Tribune reported that a former manager of a Muscle Maker Grill in Edison also filed a whistleblower lawsuit against this owner. The person who filed the pending complaint said that she complained to Marques when instructed her to throw away job applications submitted by African-American people. Her lawsuit also alleged that she was instructed by Marques to alter certain employees’ hours, justifying the actions because the cooks were “illegals”.

Recently, another whistleblower lawsuit was filed against the Muscle Maker Grill owner. The person who filed the most recent complaint alleged that Marques instructed him to not disclose his “practice of failing to pay overtime to employees who worked more than 40 hours,” during a visit by the Department of Labor, the lawsuit stated. After the whistleblower had the interview with the inspector, Marques questioned what he had said during the 30-minute interview. The manager said that he had not reported any violations, but Marques did not believe him due to the length of the interview. When he reported this conversation to his supervisors, he was fired.

Whistleblowers are individuals who file lawsuits on behalf of the US government when they have information about someone’s financial wrongdoings, such as tax fraud. These anonymous tipsters are entitled to receive a portion of the money recovered. Recently, it was reported that the Internal Revenue Service (IRS) handed out $53 million to whistleblowers in fiscal 2013, including one reported payment of $38 million.

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Amedisys Agrees to Pay $150M to Settle Whistleblower Claims

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Amedisys, Inc. has agreed to pay $150 million to settle a whistleblower lawsuit alleging that the national home health care company violated the False Claims Act by submitting false billings to the Medicare program. According to a press release issued by the Department of Justice on Wednesday, the company was pressuring employees to bill for services that did not provide or were unnecessary.

“It is critical that scarce Medicare home health dollars flow only to those who provide qualified services,” Stuart F. Delery, Assistant Attorney General for the Civil Division, stated in the release.  “This settlement demonstrates the department’s commitment to ensuring that home health providers, like other providers, comply with the rules and don’t misuse taxpayer dollars.”

There have been allegations that Amedisys offices improperly billed Medicare for ineligible patients and services between 2008 and 2010. Allegedly, management pressured employees to bill Medicare for medically unnecessary nursing and therapy services to patients who were not homebound and otherwise misrepresented the patients’ conditions to increase Medicare payments. These billing violations were committed in order to benefit Amedisys financially, rather than help patients. The settlement helped resolve these allegations.

The settlement also helped resolve other allegations of Amedisys’ wrongdoing. According to the release, it was alleged that the company maintained improper financial relationships with referring physicians. The United States alleged that Amedisys violated statutory requirements under the Anti-Kickback Statute and Stark Statute by providing patient care coordination services to a private oncology practice in Georgia at below-market prices.

“Home health services are a large and growing part of our federal health care system,” Sally Quillian Yates, United States Attorney for the Northern District of Georgia, stated in the release.  “Health care dollars must be reserved to pay for services needed by patients, not to enrich providers who are bilking the system.”

The release stated that “Amedisys also agreed to be bound by the terms of a Corporate Integrity Agreement with the Department of Health and Human Services – Office of Inspector General that requires the companies to implement compliance measures designed to avoid or promptly detect conduct similar to that which gave rise to the settlement.”

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Nurse who filed Whistleblower Lawsuit will Receive $15 Million in Settlement

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A nurse from Monroeville, Alabama will receive $15 million for her whistleblower claims against healthcare company Amedisys Inc., AL.com reports. April Brown filed a federal whistleblower suit in 2010 against Amedisys alleging that the company submitted false home healthcare billings to Medicare for services, thereby violating the False Claims Act. On Wednesday, U.S. Attorney for the Northern District of Alabama and Department of Justice officials announced that Amedisys agreed to pay $150 million to settle the suit.

Amedisys is a home health company based in Baton Rouge, Louisiana and operates in 37 states. The company admitted no wrong-doing in settling the case, but justice department officials say otherwise. “Amedisys made false Medicare claims, depriving the American taxpayer of millions of dollars and unlawfully enriching Amedisys,” stated Vance in a press release. “The vigorous enforcement work by assistant U.S. attorneys in my office, along with their colleagues in North Georgia, Eastern Pennsylvania, Eastern Kentucky and the Civil Division of the Justice Department, has secured the return of $150 million to the taxpayers and stands as a warning to future wrongdoers that we will aggressively pursue them.”

According to the justice department statement, the settlement also resolves allegations that Amedisys had inappropriate financial ties with referring physicians. The U.S. alleged that the company’s relationship with a private oncology practice in Georgie violated statutory requirements under the Anti-Kickback Statute and the Stark Statute, which restricts such relationships. According to allegations by the United States, Amedisys provided certain services to the practice at below-market prices.

Brown alleged that while she worked as a home health nurse in the Monroeville area, the company told her to bill for services that she was not actually providing or were unnecessary. Amedisys nurses check off boxes on computerized forms when they visit patients, but the forms were allegedly set up for the highest level of service and did not reflect the true status of patients’ health.

When Brown questioned these actions, she was fired. According to her attorney the single mother worked part-time shifts at a local hospital and cleaned condos to support herself; at one point she faced foreclosure on her home.

Brown was not the only one to sue Amedisys. Six other lawsuits were filed around the country with similar allegations. All cases were consolidated in federal court in Pennsylvania and sealed from public view until the settlement was announced.

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