Medicare and Medicaid set highly strict guidelines with regard to patient care. Patients are required to be under a specific care plan at all times, and caretakers must maintain certain threshold levels of competence and licensure in order to treat patients. Any deviation from state or federal guidelines could immediately trigger liability under the False Claims Act (or state-level equivalent), provided the facility was aware of the issues and continued to intentionally submit false claims for reimbursement.
In a recent case settled under Maine’s Whistleblower Protection Act, the False Claims Act, and the Human Rights Act, certain allegations were lodged against a small mental health center reportedly failing to uphold the requirements of treating mental health patients. The settlement amount, which has not been disclosed, included a percentage portion for the whistleblower – a former employee who was terminated after deciding to come forward with her information.
Details of case against Oxford County Mental Health Services
Inpatient mental health care requires highly-specific plans for each individual patient, as no two patients suffer from an identical set of symptoms. Under Medicare (which covers inpatient mental health care for up to 190 days) or Medicaid (which covers long-term care) regulations, care plans must be updated on a regular basis for each patient and tailored to meet that patient’s individual needs. Likewise, psychiatric patients must have access to regular counseling and monitoring from mental health professionals.
According to the complaint, the Oxford County Mental Health Services was failing to update patients’ care plans, allowing some to fall months behind before being updated. What’s more, the whistleblower alleged that patients did not have access to counseling or other necessary services listed in their care plans. Upon bringing these issues to the attention of supervisors and management, the whistleblower was labeled as “aggressive,” and thereafter terminated. While her termination notice cited an “aggressive attitude” and disrespectful attitude as the reason for the termination, the whistleblower asserted that she was fired for exposing improper patient care.
The government did not opt to intervene in the case, and her final settlement amount has not been disclosed at this time. However, successful False Claims Act plaintiffs often receive up to 30 percent of the total settlement amount.
Retaliation is an unfortunate, but realistic, component to the whistleblower experience for some plaintiffs. Fortunately, retaliating against an employee for choosing to report allegations of wasteful fraud is considered an actionable form of misconduct in and of itself. For the plaintiff in today’s case, her settlement undoubtedly took this into consideration, as juries have routinely awarded large verdicts against companies for wrongfully terminating employees.
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