For those who miss the webinar last night Perspective of In-House Counsel on Government Investigations by Tina Rao, JD Chief Counsel of Healthcare, Maxim Healthcare Services, Inc.

it was very informative and if you don't know Maxim's story you should read  and learn about it.  Here are just some of the facts:

 

 

 

An alleged nationwide scheme by Maxim Healthcare Services, Inc. to defraud government healthcare programs became public today when a whistleblower lawsuit was unsealed by the federal court in New Jersey.
Maxim is a Maryland corporation that provides home health and nursing staffing services nationwide.
By agreeing to pay $121 million in what the United States Department of Justice called its largest civil recovery in a home health care fraud case ever,  Maxim settled allegations by a Medicaid recipient who alleged in court documents filed in 2004 that the company billed Medicaid in his name for home healthcare services he did not receive. United States ex rel. West v. Maxim Healthcare Services, Inc., No. 04-4906 (D. N. J.).
The whistleblower, Richard W. West, 63, of New Jersey, together with the United States of America and 41 states, settled allegations that, from October 1998 through May, 2009, Maxim billed Medicaid and the United States Department of Veterans' Affairs for services it did not provide. The settlement also resolved allegations that Maxim improperly billed government programs for services provided by certain of its offices that were unlicensed.
According to the whistleblower's lawyer, Robin Page West (no relation) of Cohan, West & Karpook, P.C. In Baltimore, MD, "This settlement demonstrates that citizens and the government can work side by side to root out fraud in our healthcare system. Fraud makes healthcare more expensive for everyone, and people like Mr. West who receive benefits from government healthcare programs can play an important role in, as well as be rewarded for, discovering and alerting the government to fraudulent billing."
The whistleblower Complaint was filed by Mr. West under "qui tam" provisions of federal and state False Claims Acts after he uncovered the conduct and reported the problem to the government. Federal and state False Claims Acts allow private citizens with knowledge of fraud to help the government recover ill-gotten gains and additional civil penalties. 
These statutes allow the government to collect up to three times the amount defrauded, in addition to civil penalties of $5,500 to $11,000 per false claim.

Whistleblowers, known as "qui tam relators," can receive between 15 and 30 percent of the government's recovery.
The federal government also charged Maxim with conspiracy to commit health care fraud, and entered into a deferred prosecution agreement (DPA) with the company that  will allow Maxim to avoid a health care fraud conviction on the charges if it complies with the DPA’s requirements.  
As of September 12, 2011, nine individuals – eight former Maxim employees, including three senior managers and the parent of a former Maxim patient – have pleaded guilty to felony charges arising out of the submission of fraudulent billings to government health care programs, the creation of fraudulent documentation associated with government program billings, or false statements to government health care program officials regarding Maxim’s activities.  

The government’s criminal complaint accuses Maxim of submitting more than $61 million in fraudulent billings to government health care programs for services not rendered or otherwise not reimbursable.   The government stated that its investigation revealed that the submission of false bills to government health care programs was a common practice at Maxim from 2003 through 2009

quoted from here