Home Health & Hospice Week

Qui tam cases on the rise, experts warn.

A whistleblower lawsuit attacking your home care organization may not come from where you'd expect.

Case in point: A billing company employee filed a qui tam suit against Apria Healthcare Inc. earlier this year. Xandra Jarl, an employee of Chicago-land Billing Center in Machesney Park, IL, accused Apria of submitting false claims.

Jarl alleged that Apria billed Medicare, Medicaid and other insurance companies without obtaining assignment of benefits forms properly signed by patients. After repeatedly informing Apria employees of the billing problems, and subsequently being demoted and quitting her job, Jarl filed suit.

Jarl accused Apria's St. Louis operation of manipulating the computerized billing system, making it appear Apria had obtained the AOB forms when it hadn't. Jarl says she knows of 65 specific instances of such improper billing, and believes there were "hundreds, if not thousands more instances" of it, according to a U.S. District Court for the Northern District of Illinois opinion issued Sept. 13.

But the federal court shoots down Jarl's suit, saying she didn't have enough specifics to make the False Claims Act charges stick. Jarl failed to specify which Apria employees engaged in fraud, when the fraud occurred and on which specific claims, Judge Philip Reinhard notes in the dismissal. She even fails to say why the "improper billings" constituted fraud. Whistleblowers See Providers as Cash Cows "There is no doubt that the number of whistleblower cases is increasing," warns Burtonsville, MD-based health care attorney Elizabeth Hogue.

"We are seeing more and more qui tam situations," reports attorney Liz Pearson with Covington, KY-based Pearson & Bernard.

Attorney Ron Clark with Arent Fox in Washington, DC worked for the Department of Justice as senior trial counsel, supervising qui tam lawsuits from the mid 1980s to 1995. Back then, the "general rule of thumb is that the number of cases doubled every year," he relates, and that figure hasn't changed much. By the end, "I was afraid to see the mailman walk down the hallway" because of the number of cases pouring in, Clark quips.

Whistleblower suits are so popular because they can be very profitable for the qui tam relators - and the attorneys who represent them, Pearson notes. "There's just so much money to be made if you're a successful relator," Clark agrees.

Once whistleblower cases started reeling in hundreds of millions of dollars, law firms started aggressively soliciting potential qui tam relators by placing ads in medical professional magazines and other venues, Clark notes.

And regulators love these suits "because they potentially make their jobs so much easier," Hogue says. Are You a Prime Target? Health care providers have made juicy targets because they are usually quite willing to settle rather than embark on a [...]