Whistleblower Attorneys Blog
A teenager who died after receiving mental healthcare services from unlicensed and underqualified professionals is the impetus behind a False Claims Act lawsuit handled by Greene, LLP on behalf of the late Yarushka Rivera. The case is now before the U.S. Supreme Court. The United States Office of the Solicitor General and the Department of Justice argued before the Supreme Court on April 19, 2016 with assistance from Greene, LLP.
Yarushka Rivera was a teenage enrollee of MassHealth benefits (Massachusetts’s state equivalent of Medicare) and began seeing Arbour counselor Maria Pereyra in 2007 after experiencing various behavioral problems at school. Pereyra, an Arbour staff member, lacked a professional license to provide mental-health therapy. Rivera’s parents met with Pereyra’s supervisor, clinical director Edward Keohan, after Yarushka complained that she was not benefiting from counseling. During the meeting, they became worried that Keohan was not properly supervising Pereyra and was unfamiliar with Yarushka’s treatment.
Yarushka was eventually transferred to another staff member, Diana Casado, who was also supervised by Keohan. Casado too, was unlicensed. Yarushka’s parents quickly became dissatisfied with her treatment and believed that Casado too, was not properly supervised.
Missouri health care providers have agreed to pay the United States $5.5 million to settle a False Claims Act (FCA) suit. The Department of Justice (DOJ) had alleged that Mercy Health Springfield Communities and Mercy Clinic Springfield Communities violated the FCA by offering bonuses to doctors who had referred patients to the Mercy health care facilities. Such referrals are improper as they often result in the overuse of medical services, creating higher health care costs, which is ultimately paid for by the federal government through Medicare and Medicaid. 
False Claims Act decision regarding the “60-day rule” created by the Affordable Care Act (ACA), was recently decided by the United States District Court for the Southern District of New York. The Department of Justice (DOJ) intervened in the False Claims Act (FCA) lawsuit which was pursued by whistleblower Robert Kane against his former employer Healthfirst MCO. The DOJ alleges that Healthfirst committed fraud against the government when they attempted to retain over $1 million dollars in overpayments made by Medicare and Medicaid to the healthcare provider. In U.S. ex rel Kane v. Healthfirst, Inc., NO. 11-2325 (S.D.N.Y), the district court denied Healthfirst’s motion to dismiss and clarified what constituted “identification” under the “60-day rule”. 
k the US Court of Appeals for the Fourth Circuit affirmed a South Carolina District Court judgment against Tuomey Healthcare System. The damages and penalties against Tuomey totaled $237,454,195 as decided in United States ex rel. Drakeford v. Tuomey Health Care System, Inc. A jury had found the defendant liable under the False Claims Act for their reporting of false claims to Medicare. The decision ends a case which has been under litigation for nearly ten years.