On its website, Bayada Home Health Care urges its employees to “do the right thing.” Three former employees believe they’ve done just that by filing a whistleblower lawsuit that accuses Bayada of fraudulent Medicare billing.
There is a difference in how government health care programs reimburse health care providers for Medicare Part A services as compared to Part B and Part D Medicare services. Some commentators believe that the different arrangements tempt some health care providers to create schemes to increase profits through reimbursement.A whistleblower says that he noticed a billing discrepancy in the way a Kentucky-based pharmacy company that serves nursing homes negotiated its prices under Part A when dealing with nursing home facilities. He initiated a whistleblower lawsuit alleging that the institutional pharmacy service provider used a scheme, commonly referred to as “swapping,” to defraud Medicare.
A federal judge recently ruled that Wisconsin’s exclusion of health insurance coverage for medically necessary gender reassignment surgery violates the federal Civil Rights Act. U.S. District Judge William Conley said the denial of coverage for two University of Wisconsin-Madison employees who are transitioning to female is a form of prohibited sex discrimination.
Creating unfair incentives to bring in business in the health industry may be the basis for a claim under the False Claims Act. Improper contracts may come in a variety of forms. Kickback schemes and similar inducements to increase revenues from Medicare or Medicaid reimbursements are often the focus of health care fraud lawsuits. Private individuals may initiate a lawsuit on behalf of the government to expose fraud in government contracts.
If you go to the Department of Labor’s Milwaukee office and ask, you’ll find that when an employee returns from leave under the Family and Medical Leave Act, “he or she must be restored to the same job or to an ‘equivalent job’.”
Health care fraud costs taxpayers an exorbitant amount of money. The federal government, however, does not always detect fraudulent practices in processing Medicare, Medicaid, Tricare and similar reimbursement invoices from health care providers nationwide. Many instances of fraud related to government contracts and health care programs are discovered by workers in the relevant industries. Health care workers at any level may detect irregularities in billing practices that unfairly cost taxpayers more money than the services are worth.
Six years ago, a Department of the Interior employee reported to his supervisors that the federal department had violated the National Environmental Policy Act in order to make it easier for Arctic Ocean oil exploration. When Jeffrey Missal's supervisors showed little interest, he reported the infraction to the department's Inspector General.
The problem has spread from coast to coast, across the heartland and from north to south. Sexual misconduct in the workplace is a nationwide problem that affects people of any age in any industry. Many expect that lawmakers will put new protections into place that will make it easier to report sexual discrimination, harassment and retaliation, but those hopes might be misplaced.