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Medicare Fraud Leads to $1.5 Million Award for False Claims Act Whistleblower

On November 16, the Department of Justice announced that it had entered into a settlement with Kaiser Foundation Health Plan of Washington, formerly known as Group Health Cooperative (GHC) related to claims brought by a False Claims Act whistleblower.

Fake Diagnosis Medicare Fraud

Teresa Ross—a former employee for Group Health Cooperative—sued the company under the False Claims Act, which allows whistleblowers to sue companies for false claims made to the government and to share in any recovery. The lawsuit alleged that Global Health Cooperative deliberately submitted false diagnosis to Medicare for Medicare Advantage, which resulted in inflated payments from Medicare. Group Health allegedly lied about its diagnosis with the knowledge that Medicare pays Medicare Advantage Organizations less for healthier beneficiaries’ and more for sicker ones.

“When insurance providers take advantage of Medicare and falsely claim that they are entitled to repayment for unsupported diagnoses, American taxpayers suffer in the form of higher costs,” stated U.S. Attorney James Kennedy, Jr. of the Western District of New York. “We will continue to work to ensure that these programs are not defrauded and that monies are not paid for unwarranted claims.”

The False Claims Act provides that whistleblowers receive between 10% to 30% of the money the government recovers from the wrongdoer. In this case, Ms. Ross was awarded approximately $1.5 million for blowing the whistle on Medicare fraud.

If You See Corporate Fraud, Talk to An Experienced Whistleblower Attorney

Whistleblowers like Ms. Ross are critical to our system of law enforcement and to stop corporate fraud. Our experienced whistleblower attorneys can help you navigate False Claims Act cases and other complex whistleblower laws.

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