On December 23, 2009, Visiting Physicians Association, which is based in Farmington Hills, Michigan, agreed to pay the United States and the State of Michigan $9.5 million to settle allegations that the association violated the False Claims Act. Visiting Physicians Association is a Michigan professional corporation which has provided home health services at various times in Michigan, Ohio, Georgia and Wisconsin.
The agreement settled allegations that Visiting Physicians Association submitted claims to the Medicare, TRICARE and Michigan Medicaid for unnecessary home visits and care plan oversight services, for unnecessary tests and procedures, and for more complex evaluation and management services than the services that Visiting Physicians Association actually provided.
This settlement resolved four lawsuits filed by private plaintiffs under the qui tam or whistleblower provisions of the False Claims Act, which permit private parties to file an action on the government’s behalf and share in any recovery. This settlement provides that the four whistleblower plaintiffs will collectively receive a total of approximately $1.7 million.
Attorney Commentary: While many health care providers are careful to avoid any "criminal" conduct and they know they will probably never be prosecuted for health care fraud -- it is more difficult to avoid having a former employee hire a law firm to file a qui tam suit.
Question: What is the number one thing you can do to avoid a qui tam lawsuit?
Answer: Compliance plan. Have it and maintain it.
Compliance plans have many merits, several of which relate to possible qui tam actions. Many individuals, particularly nurses and health care employees, become relators because of frustration stemming from repeated unsuccessful reports of suspected misconduct to management. An effective compliance plan provides a mechanism for action to be taken on such reports and in some cases will foreclose potential relators from concluding they have no alternative other than filing a qui tam.
In addition, effective compliance plans are designed to prevent and/or detect inappropriate conduct through reliance on intensive training, internal auditing, hotlines and other mechanisms. It is obviously the preferable course to have identified and resolved a potential problem through a compliance plan than to have it uncovered by a relator and employed as the foundation for a whistleblower action.
Posted by Tracy Green. Should you have any questions regarding your own situation or this post, you can email Tracy at tgreen@greenassoc.com. Green & Associates in Los Angeles, California focuses their practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers. Their website is: http://www.greenassoc.com/
