Defendant's Attorney: No appearance
Description: Montgomery, Alabama civil litigation lawyer represented Defendant accused of violating the False Claims Act (FCA) by submitting claims to Medicare for occupational therapy services that they did not provide.
The FCA is a federal law that imposes civil liability on any persons or entities who submit false claims for payment to the federal government or its contractors. It imposes damages three times the loss caused by the false claims and a civil penalty between $13,508.00 to $27,018.00 per false claim. The FCA is the primary authority used by the Civil Division of the United States Attorney’s Office to redress fraud, waste, and abuse within federal programs, including Medicare.
Diversicare is a group of private companies providing long-term care and rehabilitation services in approximately 43 locations across five states — Alabama, Mississippi, Tennessee, Texas, and Kansas. Prior to March 1, 2023, Diversicare operated the Canterbury Health Care Facility in Phenix City, Alabama.
The civil settlement resolves a lawsuit that a former Diversicare employee brought under the qui tam, or whistleblower, provisions of the FCA. The complaint alleged that Lemons and James falsified occupational therapy records when they clocked into work at Diversicare’s Canterbury facility, left the premises, and “moonlighted” for other home health care companies in the area, meanwhile billing for services at Diversicare that they did not perform. The complaint also alleged that Diversicare permitted and even condoned these practices and knowingly submitted false claims to Medicare for reimbursement for these services.
The United States has intervened in the lawsuit for purposes of settlement. The settlement resolves the allegations that from March 1, 2018, through September 25, 2020, Diversicare, Lemons, and James submitted, or caused to be submitted, false claims to Medicare Part A for occupational therapy services that were not rendered to patients at Canterbury Health Care Facility.
The FCA permits private citizens to initiate a suit on behalf of the United States and share in any recovery. The whistleblower who brought the lawsuit will receive in excess of $200,000.00 of the settlement as his share of the government’s recovery in the matter.
The case was investigated by the United States Attorney’s Office for the Middle District of Alabama in cooperation with the Office of Inspector General for the United States Department of Health and Human Services. Assistant U.S. Attorneys MaryLou E. Bowdre and Samantha R. Miller represented the United States in the matter, assisted by Investigative Analyst Rita E. Richard, Paralegal Specialist Stacey H. VanAlst, and Investigator (Contractor) Gregory T. Holston.
The claims resolved by the settlement are allegations only, and there has been no determination of liability.
The False Claims Act (FCA) is a federal law that imposes liability on persons and companies who defraud governmental programs. It is the federal government's primary litigation tool in combating fraud against the government.
The FCA was enacted in 1863 in response to defense contractor fraud during the American Civil War. The law has been amended several times since then, most notably in 1986.
The FCA has two main provisions:
Qui tam: This provision allows private citizens to file lawsuits on behalf of the government (called “qui tam” suits) against those who have defrauded the government. Private citizens who successfully bring qui tam actions may receive a portion of the government's recovery.
Anti-retaliation: This provision protects employees who report fraud against the government from retaliation by their employers.
The FCA has been very successful in recovering money for the government. Since 1986, the government has recovered over $60 billion in FCA cases.
If you believe that you have information about fraud against the government, you can file a qui tam lawsuit. You can also contact the Department of Justice's Civil Fraud Section.
Here are some resources for more information about the FCA:
Department of Justice: https://www.justice.gov/civil/false-claims-act
National Whistleblower Center: https://www.whistleblowers.org/
False Claims Act Lawsuit Center: https://www.falseclaimsact.com/
Outcome: Defendant agreed to pay $1,377,696.00 to resolve allegations.