$2.1 Million Settlement: Genesis Health Ventures Medicare Fraud Case
Major qui tam settlement involving Medicare billing fraud for therapy services in nursing homes demonstrates the power of whistleblower protections under the False Claims Act.
Settlement Overview
Robin Page West announced in September 2001 the settlement for $2,095,000.00 of a Federal False Claims Act/Qui Tam suit filed in the Eastern District of Pennsylvania in April of 2000 in which she represented the plaintiff/relator Michael P. LaRosa.
As a result of this and three other Qui Tam suits against Genesis Health Ventures, Inc., the United States government entered into a Settlement Agreement in which the Defendant agreed to pay $2,095,000.00 to the government.
Whistleblower Rewards and Attorney Fees
The Relators in the four cases collectively received $353,550.00 as their share of the government's recovery. This represents approximately 15-17% of the total settlement amount, consistent with standard qui tam reward percentages when the government intervenes in a case.
Defendant paid an additional $79,850.00 for relators' statutory attorneys fees and costs, demonstrating how the False Claims Act ensures whistleblowers can pursue justice without bearing the financial burden of litigation.
The Fraud Allegations
The United States alleged that, among other things, Genesis submitted bills to Medicare for therapy services provided to nursing home patients that did not reflect the actual amount of time spent, resulting in Genesis being reimbursed by Medicare more than it was entitled to receive.
This type of healthcare billing fraud is unfortunately common in the nursing home industry, where providers may inflate the time or complexity of services to obtain higher Medicare reimbursements. The False Claims Act provides a powerful tool for insiders with knowledge of such fraud to come forward and help recover funds for taxpayers.
Defendant settled the suits but did not admit any liability to the government.
Robin Page West's Track Record of Success
Other major Federal False Claims Act/Qui Tam suits filed in Maryland in which West represented the relator and which were settled include:
- •U.S. ex rel. Scott v. CIGNA — $8.9 million (2000)
- •U.S. ex rel. Dorer v. Corning Life Sciences — $6.8 million (1998)
- •U.S. ex rel. Fletcher v. MetPath — $8.6 million (1995)
Published Expertise
West is the author of "Qui Tam Litigation," an article published in the Fall 2001 issue of Litigation, the Journal of the American Bar Association's (ABA) Section of Litigation, and a book published by the ABA in 2000, Advising the Qui Tam Whistleblower, which is described in detail elsewhere on this web page.
Do You Have Information About Healthcare Fraud?
If you work in healthcare and have knowledge of Medicare or Medicaid billing fraud, you may be entitled to a significant financial reward under the False Claims Act. Our experienced qui tam attorneys can evaluate your case confidentially.
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