When Family Ties Lead to Corruption: A Story of Fraud

False Claims Act , Healthcare Fraud

 In a twisted example of “family bonding,” a mother-and-son team were found to have together violated the False Claims Act by submitting over $25.2 million in claims to Medicare over the course of six years, the majority of which were discovered to be fraudulent. From 2009 to 2015, the pair committed large-scale Medicare fraud through the agencies they owned: Nursing Home Psychological Services and Psychological Care Services. This scheme victimized Medicare recipients throughout the Southeastern United States, as NHPS and PCS had contracts with eight separate nursing homes across Lousiana, Alabama, and Mississippi.

Over the lengthy course of their collusion, the two were responsible for billing the government healthcare program thousands of times for psychological testing that was either unnecessary or not administered, leading Medicare to pay over $13 million in false claims. Together, they were ordered to pay over $20 million in restitution as a result of their actions.

During the course of the investigation, it was discovered that two employees played large roles in the fraud as well. A clinical psychologist for the agency admitted to administering tests to nursing home residents who were “either non-responsive or were otherwise unable to meaningfully participate.” The other party played a role in the cover-up by supervising multiple physicians and encouraging the falsification of documents to ensure reimbursements were received for these alleged “therapy sessions.”

Sadly, these practices are all too common in settings where the patient population is largely composed of senior citizens, as they are generally unable to report the crimes being committed against them and are often unaware that these activities are even taking place.

Medicare fraud is an ongoing concern, especially in environments such as nursing homes in which medical practitioners can prey on our elderly and most vulnerable citizens with little risk of detection. Though cases such as this may be difficult to expose, bringing those who take advantage of the Medicare program to justice is not only a moral responsibility but may also result in a considerable reward under the qui tam provision of the False Claims Act. It is vital to the well-being of the victimized patients and the prospective longevity of government healthcare programs alike that any knowledge of fraudulent activity is brought forward in an attempt to bring these schemes to light.

Whistleblower Justice Network Can Help You

Whistleblower Justice Network partners with potential whistleblowers who believe that those who bilk the United States healthcare system should be brought to justice. We know it can be a difficult decision to come forward with such sensitive information, and applaud the fortitude it requires to do what is right above all else.

If you have meaningful information regarding healthcare fraud that you believe is in violation of the False Claims Act, Whistleblower Justice Network can help. Working alongside world-class legal counsel, we will ensure you are protected to the fullest extent of the law and that you receive credit for the information you bring to the U.S. government. Partnering with whistleblowers is all we do. Visit us at www.whistleblowerjustice.net, or call us at 844-WJN-4ALL.

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