An investigation that started in February 2013 resulted in the settlement of a Qui Tam case against CareCore National LLC. A licensed nurse who was employed at CareCore National LLC came forward with evidence of the unlawful practice that was being conducted. After two law firms represented the nurse, a False Claims Act (FCA) lawsuit was filed under seal with the federal court in Southern District of New York. The settlement called for CareCore to pay $54 million. Since the case was filed using the provisions in the FCA, the whistleblower award of roughly 20% or $10 million dollars will be given to the woman who had the courage to bring this matter to the government’s attention through her whistleblower lawyer.

The Qui Tam Case Against CareCore National LLC

On the 21st February 2013, a whistleblower case was filed secretly, under seal, against the health care agency CareCore National LLC. A licensed nurse, known as the relator in the case, brought evidence of misconduct in her workplace to two whistleblower law firm who focus on prosecuting these violations.

CareCore National LLC is a company based in Bluffton, South Carolina. They have several branches throughout the United States. The company provides an authorization service for doctors and other facilities who need to verify whether specific types of tests need to be conducted on patients, ultimately promoting their services as a cost-saving way to ensure only the necessary tests are performed on a doctor’s patients.

When any information is missing from a submitted file or when the authorization request submitted to the company does not comply with the set criteria, then nurses are instructed to submit them back to the doctor who originally submitted the request. The doctor would then be requested to review the request and provide the data that is missing from the authorization request.

According to the nurse who brought the whistleblower case forward, however, the company instructed nurses to instead rubber stamp all authorization requests as “Process As Directed.” This means the request is not submitted back to the doctor for review, but rather passed on and the tests are authorized, even when they are not truly necessary. In turn, this led to thousands of patients undergoing diagnostic tests like MRIs, even when not necessary to assist in their diagnosis. Claims were made from federally funded insurance providers. Ironically, the process was nicknamed P.A.D. and jokingly referred to as Padding the bill, which is not joke to taxpayers who every year have to foot the bill for billions of dollars in Medicare and Medicaid Fraud.

Conclusion

Thousands of whistleblower cases against healthcare organizations are filed each year with whistleblowers exposing corruption in such areas as Medicare and Medicaid Fraud.   The False Claims Act provides a way for the government to be repaid for fraudulent misconduct that causes them a loss. These cases play a vital role in preventing further fraud and bringing existing fraudulent activity against federally funded health insurance plans to the attention of the right lawyers who focus on whistleblower cases. If you’re wondering “How do I blow the whistle?” or “Do I have a whistleblower case?” you should speak with a whistleblower law firm like Brown, LLC who can provide a free confidential consultation.

CareCore National LLC Pays $54M Settlement In Qui Tam Case