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Florida Business, Whistleblower, & Securities Lawyers / Blog / Qui Tam/Whistleblower / Patient Exposes $150 Million Medicaid Fraud

Patient Exposes $150 Million Medicaid Fraud

Maxim Healthcare Services Inc. (“Maxim”), one of the nation’s largest providers of home healthcare services, has agreed to settle criminal and civil charges relating to a nationwide scheme to defraud Medicaid and the U.S. Department of Veterans Affairs of more than $61 million. To date, nine individuals, including two Florida residents, have pleaded guilty to felony charges arising out of the submission of fraudulent billings to the U.S. government.

The fraud was initially brought to light by whistleblower, and Maxim patient, Richard West when he filed a qui tam action alleging that Maxim had improperly billed Medicaid for 735 hours of home nursing care that he never received. West, a Vietnam veteran with muscular dystrophy, began receiving in-home care from Maxim in 2003 but in 2004, New Jersey officials suspended his Medicaid benefits claiming he had exceeded his monthly cap. West had kept good records and knew that was incorrect. After some investigating, West determined that Maxim had billed Medicaid $20,000 for care that he had never received. West complained to his social worker but she did nothing. Then he complained to New Jersey officials who ignored him. He then complained directly to Medicaid but similarly, they took no action. So, West found a qui tam lawyer who filed a whistleblower lawsuit under the False Claims Act, finally triggering an investigation of Maxim.

The investigation revealed that the fraud went far beyond just the improper billing for Richard West. The criminal complaint accused Maxim of submitting more than $61 million in fraudulent billings to government health care programs for services not rendered, or otherwise not reimbursable. The investigation revealed that from 2003 to 2009, the submission of false bills to government health care programs was a common practice at Maxim.

The Department of Justice announced that Maxim has agreed to pay $150 million to resolve the charges. Of that, whistleblower Richard West will receive $15.4 million.

If you have any firsthand knowledge, information, or evidence related to any federal, state, county or city government fraud, you should speak with an experienced qui tam lawyer who can help you understand your legal rights and help you obtain the compensation you deserve.

If you have a claim, contact the Florida whistleblower attorneys at Rabin Kammerer Johnson for a free and confidential consultation by calling toll free at 877.915.4040.

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