One of the key challenges in bringing a False Claims Act (FCA) claim is to make a compelling case to the jury that the evidence proffered by the plaintiff justifies the full amount of damages requested. Oftentimes, a jury may award less than what is requested by the plaintiffs, or even where a jury does award the full amount, a judge may lower the total amount that the defendant is required to pay. But, in some cases, a judge can actually increase the amount of money awarded in a FCA claim – thereby increasing the amount of money that a whistleblower will take home as a reward – based on such issues as egregious conduct including upcoding of Medicare/Medicaid billing. That is exactly what occurred in a Florida federal court in March when the federal judge presiding over an FCA claim brought by nurses against Consulate Health Care increased the jury’s verdict from $115 million to $347 million, meaning the whistleblower could walk away with tens of millions of dollars in financial recovery. A plaintiff in a successful FCA claim typically receives 15% to 25% of the total recovery as a reward.
Why the Judge Increased the Award
The claims, brought by nurse Angela Ruckh, alleged that several Consulate Health Care entities consistently submitted “upcoded” Medicare claims to the federal claim. Upcoding is when a health care entity provides medical services to a client and then submits a reimbursement claim to the federal government via the Medicare or Medicaid program for more expensive services than were actually performed.
The federal jury presiding over Ruckh’s FCA claims found that there was sufficient evidence to support her claim that the four Consulate health care providers had submitted upcoded claims via Medicare and Medicaid to the government and awarded $115 million in damages, a number reached by extrapolating the specific examples of upcoding across the health care providers’ businesses.
Judge Merryday, the judge presiding over the case, later “trebled” the damages up to $347 million based on the fraudulent nature of the defendant’s action. Trebling of damages is often permitted as a way to punish a defendant above and beyond the costs of their misdeeds and to deter other defendants from taking illegal action as a profit-creating measure.
Pursuing Your Own Medicare/Medicaid Whistleblowing Claim
At Kreindler & Associates, we understand that the decision to become a whistleblower is not an easy one. The government relies on courageous people like you to come forward with information that can stop harmful Medicare/Medicaid fraud. Our experienced healthcare fraud attorneys will work with you every step of the way to determine your appropriate course of action, protect you from retaliation, and collect your much-deserved reward. If you suspect that someone is committing Medicare/Medicaid fraud, contact us today for an evaluation of your allegations.
