On March 12, Dena J. King, the U.S. Attorney for the Western District of North Carolina, announced that Family First Home Health Care, Inc. (Family First), a home health care agency in Gastonia, N.C., and its owner, Marion James, have agreed to collectively pay $600,000 to resolve claims brought under the qui tam provisions of the False Claims Act (FCA). The settlement stems from a qui tam whistleblower lawsuit filed by Heather Coleman, a former employee of Family First.
From January 1, 2015, through January 9, 2020, the company allegedly submitted thousands of fraudulent claims to Medicaid for reimbursement. They allegedly billed Medicaid for personal care services that were never performed, such as billing for in-home services when patients were hospitalized. The United States and the State of North Carolina also allege that the company and James engaged in a scheme to have family member aides provide personal care services to their family members and then fraudulently bill those services, forging documents and signatures to continue the scheme.
“Medicaid beneficiaries qualifying for personal care services are those that require assistance with daily living tasks, often the elderly. This settlement demonstrates that those who would profit from defrauding government healthcare payors while taking advantage of vulnerable patients entrusted to their care will be held accountable,” said U.S. Attorney King.
The qui tam provisions incentivize private citizens to bring a civil lawsuit on behalf of the U.S. by rewarding 15-30% of the settlement from government sanctions. Whistleblowers are vital in uncovering fraudulent activities. More than $7.3 billion in whistleblower rewards has been paid out under the FCA since 1986. In 2023, qui tam whistleblowers allowed the government to recover $2.3 billion from fraudsters.
On July 25, a bipartisan group of senators introduced the False Claims Amendments Act of 2023, which address a few technical loopholes undermining the success of the FCA. The bill is widely supported by whistleblower advocates.
“The False Claims Act is America’s number one fraud-fighting law,” said whistleblower attorney Stephen M. Kohn. “These amendments are urgently needed to ensure that whistleblowers can continue to play their key role in protecting taxpayers from corporate criminals.”
Kohn sees the passage of the False Claims Amendments Act as one of the seven most urgently needed whistleblower reforms. National Whistleblower Center (NWC), where Kohn serves as Chairman of the Board, has issued an Action Alert calling on Congress to pass the bill.
Join NWC in Taking Action:
Demand that Congress strengthen the False Claims Act
Further Reading:
Bipartisan Legislation Unveiled to Strengthen False Claims Act
More False Claims Act Whistleblower News