Government Intervenes in Ambulance Service Medicare Fraud Lawsuit Filed by Berger & Montague and Wenzel Fenton Cabassa

Government Intervenes in Ambulance Service Medicare Fraud Lawsuit Filed by Berger & Montague and Wenzel Fenton Cabassa

Philadelphia, Aug. 7, 2017, /PRNewswire/ — Berger & Montague, P.C. and Wenzel Fenton Cabassa, P.A. of Tampa are pleased to announce that the government has intervened in a False Claims Act lawsuit filed by both firms on behalf of their client against AmeriCare Ambulance Service. The lawsuit alleges that AmeriCare defrauded the government by billing Medicare for thousands of medically unnecessary services.

AmeriCare, a company based near Tampa, Fla., provides ambulance transportation services and often provides these services to Medicare beneficiaries. Medicare only covers ambulance transportation services when other methods of transportation (such as a non-ambulance stretcher van or a car) would endanger a patient’s health. The firms’ client worked as a paramedic at AmeriCare, and during his employment, became aware that AmeriCare was providing medically unnecessary ambulance transportation services to Medicare beneficiaries.

The client alleges that AmeriCare routinely asked him to falsify records to misrepresent the medical condition of patients to create the false impression that the services were medically necessary. When he expressed concerns about this to AmeriCare management, he was fired. The client then filed claims under the False Claims Act. For more details please visit our new site http://lenderliabilitylawyer.com.

In July 2017, the government announced that it was intervening in the case against AmeriCare and recently filed a complaint which provided extensive details of AmeriCare’s misconduct. The government alleges that AmeriCare submitted thousands of claims to Medicare for medically unnecessary ambulance transportation services and thus received government funding for services not covered by Medicare. During its investigation, the Government could speak with various administrators and other employees at AmeriCare, who confirmed that AmeriCare had implemented this scheme.

The firms’ client is also pursuing a separate claim based on AmeriCare’s decision to terminate him when he expressed concerns about this scheme. The False Claims Act specifically forbids employers from retaliating against employees for attempting to investigate or stop violations of the False Claims Act.

Shauna Itri, counsel for the whistleblower stated: “We are extremely proud to be representing Ernest Sharp in this case.” Itri further stated, “The government has been impressive in the way it diligently investigated this ambulance transport case.” Wenzel added, “The United States faces a crisis because of the rising cost of healthcare. Fraud must stop — it hurts patients who won’t be able to get care. All healthcare workers should be vigilant about their employer’s misdeeds and call us so we can help stop fraud and protect their job rights.”

N.D. Illinois Dismisses Illinois Whistleblower Act Claim

N.D. Illinois Dismisses Illinois Whistleblower Act Claim

The U.S. District Court for the Northern District of Illinois recently granted a Rule 12(b)(1) and (6) motion to dismiss a former employee’s complaint alleging retaliation under the Illinois Whistleblower Act (“IWA”). Huang v. Fluidmesh Networks, LLC, No. 16-cv-9566 (N.D. Ill. July 18, 2017).

Background. Plaintiff was a Supply Chain and Manufacturing Manager for Defendant. He alleged that Defendant’s Chief Technology Officer (“CTO”) falsely told a third party that a publicly-traded client intended to purchase Defendant. Plaintiff alleged that because he thought this allegedly false information could impact the client’s stock price, he reported it to his direct supervisor, the CTO, and the CTO’s supervisor. Plaintiff claims that he told these individuals that the disclosure of the information was “illegal” and that he would report the violation to the appropriate authorities. Plaintiff’s employment was terminated subsequent to his internal reports and he alleged that he received no explanation as to the basis for the termination.

Ruling. Following his discharge, Plaintiff filed a complaint alleging that his employment was terminated in violation of the IWA. Defendant moved to dismiss the claim, arguing that Plaintiff failed to state a claim under the IWA, as he did not allege that: (1) he reported a violation externally (as required by 740 § ILCS 174/15(a) and (b)); (2) he refused to participate in illegal activity (as required by 740 ILCS § 174/20); (3) any of his allegations involved public corruption (as required by 740 ILCS § 174/20.1); or (4) he was threatened by his employer (as required by 740 ILCS § 174/20.2). The court agreed. The court also found that Plaintiff lacked standing to bring an IWA claim due to a “lack of any meaningful connection to Illinois,” as the only connection to the lawsuit to Illinois was that Defendant has its principal place of business in Illinois. But Plaintiff lived and worked in Taiwan and California and no one implicated by Plaintiff’s allegations lived or worked in Illinois.

Implications. This case shows that courts are apt to strictly apply the requirements of the IWA and will require a plaintiff alleging claims under Illinois state law to establish a clear nexus to Illinois.

Which employees get securities whistleblower protection? Supreme Court to resolve disagreement

Which employees get securities whistleblower protection? Supreme Court to resolve disagreement

Dive Brief

The U.S. Supreme Court has agreed to review Somers v. Digital Realty Trust Inc., a case in which the 9th Circuit ruled that employees who complain internally about securities law violations are protected from retaliation.

The appeals court held that workers can qualify as “whistleblowers” under the Dodd-Frank Wall Street Reform and Consumer Protection Act, even if they never submit their complaints to the U.S. Securities and Exchange Commission (SEC) as the law discusses.

The 2nd Circuit reached the same conclusion in 2015 but the federal appellate courts are divided; the 5th circuit ruled in 2013 that employees must file a complaint with the SEC to receive the law’s anti-retaliation protections.

Dive Insight

Many employers are hoping the Supreme Court will conclude that employees must report complaints to the SEC to obtain protection, according to the U.S. Chamber of Commerce. In a statement submitted to the Court, the business advocacy organization said that a finding otherwise would drastically expand the number of employees eligible to pursue the law’s remedies and the time in which they can sue for retaliation.

A handful of other experts, however, have said that such a finding will discourage employees from reporting violations internally, thereby denying employers the opportunity to address the issue first.

Either way, employers should have clarity on the issue in the next few months. In the meantime, businesses may want to review internal policies and agreements to ensure they don’t run afoul of SEC whistleblower rules, as the commission has recently demonstrated a new interest in the issue.