Whistleblower Attorneys Recover $1M in Medicare Fraud Case

NEW YORK, New York, February 26, 2015 – Whistleblower attorneys at the qui tam law firm of Levy Konigsberg LLP (“LK”) have successfully concluded a whistleblower or “qui tam” matter filed against a Grand Rapids, Michigan therapy provider for alleged Medicare fraud. The therapy provider, Agility Health, provides physical, occupational, and speech therapy services to patients, many of whom are Medicare patients that reside in skilled nursing facilities. Under the settlement, Agility and a skilled nursing facility have agreed to pay $1 million dollars back to the Medicare program. The whistleblowers in this matter will receive a reward of approximately $200,000 under the settlement. A press release issued by the U.S. Attorney’s Office for the Western District of Michigan can be read here.

The case was originally filed in May of 2012 by three whistleblowers—two physical therapy assistants and a licensed physical therapist—that became aware of the fraud. The whistleblowers alleged that the therapy provider, Agility Health, was improperly inflating the resource utilization group (RUG) levels of nursing facility patients to increase the facility’s Medicare Part A reimbursement. The suit also alleged that Agility had billed Medicare for Part B therapy services that were medically unnecessary or mischaracterized. The nursing facility where the alleged Medicare fraud took place also agreed to return funds to the Medicare program as part of the settlement.

After investigating the information provided by the whistleblowers, the federal government determined that it would intervene in the case. The whistleblowers were represented by LK attorneys Alan Konigsberg and Brendan Little, as well as attorney Theresa Vitello. The whistleblower’s legal team also included co-counsel Joseph Rossi, an attorney at the Grand Rapids, Michigan law firm Drew Cooper & Anding. The whistleblower award or “relator’s share” in this case—over 20 percent of the government’s recovery—is significantly greater than the minimum 15 percent reward required by the False Claims Act. “This reflects the extraordinary contributions by our clients in bringing this Medicare fraud to the government’s attention and providing the evidence needed to investigate this case,” noted Alan Konigsberg, the whistleblowers’ attorney. In addition to the amounts that will be paid to the government, the defendants will also pay the Relators’ attorneys’ fees and costs associated with the case.

The False Claims Act is a federal law allows individuals with information about fraud against government programs, such as Medicare or Medicaid, to file a lawsuit on behalf of the government. If the government recovers money as a result of the whistleblower’s claims, the whistleblower is entitled to receive 15-30 percent of the government’s recovery as a reward for stepping forward. Whistleblower claims under the False Claims Act, also known as qui tam actions, involve unique procedures and cannot be filed without an attorney according to federal law.

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