Personal Injury Blog

Elder Care Provider Ordered to Pay $6.15 Million for D.C. Medicaid Fraud

By: Allan M. Siegel

A federal D.C. judge recently ordered a Maryland-based home health care provider to pay more than $6.15 million for defrauding D.C. Medicaid. The healthcare fraud case was filed pursuant to the False Claims Act, which allows whistleblowers to report Medicare and Medicaid fraud and to receive a portion of the government’s recovery as a reward.

Speqtrum, Inc. is a home health care agency that provides elderly and disabled individuals with assistance in daily activities, including dressing, bathing, and taking medications. D.C. Medicaid subsidized Speqtrum’s service furnished to low-income individuals.

Speqtrum allegedly billed D.C. Medicaid for hours that were not worked, forged physician signatures, and failed to obtain necessary authorizations prior to providing services. Overbilling fraud is a common characteristic of healthcare whistleblower cases.

In May 2009, the D.C. Department of Health Care Finances’ Utilization Management Unit conducted an on-site audit of Speqtrum. In a random sampling of patient files, the audit revealed discrepancies between the amount of hours recorded in the file and the amount of hours billed to D.C. Medicaid. The subsequent False Claims Act alleged counts of false certification, false claims, and false statements.

In the recent federal decision assessing civil penalties against Speqtrum, the Court was unpersuaded by its arguments against the penalty. “Defendant, at the end of the day, offers nothing of substance to derail the damages-award train now entering the station,” Judge James Boasberg wrote in a September 23 opinion before entering a judgment against Speqtrum for $6,151,302.51.

If you are aware of fraud such as overbilling being committed by a healthcare company that receives Medicare or Medicaid funds, please contact the attorneys of Chaikin, Sherman, Cammarata, & Siegel. By reporting fraud against taxpayer-funded programs, you may be eligible for a substantial compensation award.