Government rewards two local therapists who blew the whistle on Carter Healthcare
Two therapists in Vero Beach and Melbourne who claim they were fired after blowing the whistle on their former healthcare employer will pocket a portion of a multi-million-dollar settlement announced last week by the U.S. Department of Justice.
Oklahoma City-based Carter Healthcare and two of its top officers paid more than $7 million to settle a lawsuit filed by the two whistleblowers who claimed that affiliates of the home-health provider defrauded Medicare by pushing therapy services for Florida seniors without regard to medical need, according to attorneys representing the therapists.
Carter Healthcare, a family-owned home-health and hospice-care network with offices around Florida, including Melbourne, Vero Beach, Port St. Lucie, denied wrongdoing but agreed to sanctions and payments, federal officials stated in a release issued Oct. 18.
The company and its affiliates also operate in Ohio, Pennsylvania, Missouri, and Kansas.
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Between 2014 and 2016, Carter Healthcare, “allegedly billed the Medicare Program knowingly and improperly for home healthcare to patients in Florida based on therapy provided without regard to medical necessity and overbilled for therapy by upcoding patients’ diagnoses.”
“Medicare fraud costs our taxpayers billions annually,” Juan Antonio Gonzalez, U.S. Attorney for the Southern District of Florida said in a statement. “We take this fraudulent activity very seriously and will continue to prosecute it to the fullest extent of the law.”
Federal officials announced the settlement the same day Carter Healthcare agreed to pay nearly $23 million to resolve a separate whistleblower case that involved allegations of kickbacks at its operations in Oklahoma and Texas.
False Claims Act
Occupational therapist Sharon Mahaffey, of Vero Beach, and physical therapist Mark Brimer, of Satellite Beach, will share almost $1.3 million as an award for their role in reporting Carter Healthcare’s Medicare billing practices that were detailed in a federal lawsuit filed after both were terminated in 2016.
They raised their fraud and employment retaliation accusations under the federal False Claims Act, which includes a provision that allows whistleblowers to sue on behalf of the government and — if they prevail — to receive a portion of any settlement paid.
Brimer, a licensed physical therapist with 36 years of experience, worked in Carter Healthcare’s Melbourne office, court records show. Mahaffey, a licensed occupational therapist with more than 30 years of experience, worked at the company’s Melbourne and Vero Beach offices.
According to their lawsuit, the two were often paired together to treat patients, "with Brimer handling the physical therapy needs and Mahaffey responsible for the occupational therapy needs of Carter patients."
In a prepared statement, their attorney Janel Quinn, with The Employment Law Group, said Mahaffey and Brimer “spoke out loudly against Carter’s insistence on medically unnecessary treatments, including the pointless therapies they were ordered to provide.”
Before the announced settlement, Quinn noted, “the only reward they’ve gotten for their integrity was a pair of pink slips.”
“This settlement offers them some real vindication,” Quinn said, “and soon they’ll bring Carter Healthcare before a jury to correct their wrongful dismissals, too.”
Their complaint in part described how the two resisted “a Carter Healthcare scheme” that required 18 home visits per patient during each Medicare certification period, regardless of a patient’s need.
Some patients, the lawsuit claimed, were incapable of benefiting from such therapy, while others tried to refuse services but were ignored.
"Carter Healthcare instructs their therapists to go to patient homes,” the suit alleged, “even if they have been rejected at the door, to persuade (or, if necessary, force) patients to continue therapy.”
Mahaffey and Brimer estimated “that at least one-third of the approximately 18,000 patient visits per 60-day certification period are medically unnecessary," the suit stated.
The two were hired in 2014 by Carter’s Florida affiliate and both were terminated within months of each other in 2016, according to their lawsuit.
Court papers claim they were fired after Carter Healthcare knew they were questioning the company’s patient protocols and Medicare billing.
Separate from their share of Carter Healthcare’s settlement with the Justice Department, both therapists are seeking money damages, including “two times the amount of back pay” and “personal injury damages for pain and suffering and loss of reputation.”
Melissa E. Holsman is the legal affairs reporter for TCPalm and Treasure Coast Newspapers, and is writer and co-host of Uncertain Terms, a true crime podcast. Reach her at melissa.holsman@tcpalm.com.
This article originally appeared on Treasure Coast Newspapers: Two local therapists whistleblowers rewarded in Medicare fraud case
