Whistleblower Awarded $631,200 In Medicare Fraud Case

A respiratory therapist in Fresno County was working at a sleep medicine center when she noticed what she believed to be Medicare fraud happening at the facility. She decided to speak out, becoming a whistleblower and exposing the scheme. As a result, she was fired from her job.

She ends up with the last laugh, though, as the case recently went to court and the jury decided to award her $631,200.

The case itself was fairly simply. The woman was not a doctor, but did have a respiratory care license. The company, which worked with people who had breathing problems like sleep apnea, told her to do the in-person evaluations. These were supposed to be done by a doctor, and she wasn’t licensed to do them. When the company billed Medicare, they then claimed that doctor visits had been done, adding significant additional costs, even though she had done those visits.

The woman eventually made her complaint and refused to do the evaluations. That’s when she was fired.

It is worth noting that the investigation did not find fraud, but did determine that the company had been over-billing. The center then had to reimburse Medicare.

However, since they had fired the 51-year-old woman for refusing to break the rules and bringing the over-billing to light, the jury decided that constituted an illegal retaliation. As such, she was given $500,000 in punitive damages and another $131,200 for emotional and economic damages.

The law has many protections for whistleblowers, and it’s critical for employees to know exactly what these are. Many are nervous to make reports for fear of losing their jobs, but this case shows that there are still legal options after a job termination.

Source: The Fresno Bee, “Medicare fraud whistleblower gets $631,200 from Fresno County jury,” Barbara Anderson, Nov. 04, 2016