Home Care Director Admits Guilt in $45 Million Fraud Scheme

A former home health care executive has pleaded guilty for her part in a fraud scheme worth $45 million that involved falsifying medical records of Medicare beneficiaries.

Avelina Fiel, the former director of nursing of Illinois-based Pathways Home Health Services LLC, pled guilty this week to a single count of conspiracy to commit health care fraud, Law360 reported. Fiel’s actions directly led to at least $1.5 million in false payments to the home health agency.

She admitted that she pressured at least one employee to falsify medical records to make it appear patients were sicker than they really were during her time at Pathways—between 2012 and 2014. Field also said she told quality assurance supervisors to not adhere to physicians’ recommendations when they refused to certify patients as homebound. Instead, patients were sent to a second physician who was unaware of the first physician’s refusal. read more »

Oracle: State improperly concealed whistleblower's bombshell account of Cover Oregon debacle

On the eve of a key hearing Oracle is asking a judge to throw out the state’s billion-dollar fraud lawsuit over the Cover Oregon website debacle. The company accuses the state of playing hide-the ball to dishonestly conceal Oregon's top witness.

Former Oracle manager David Jurk’s blistering assessment of the company’s work— claiming overbilling, incompetence, antiquated and poorly integrated products, repeated misrepresentations and fraud — is a central element of the state’s case. And now, thanks to the new arguments raised by Oracle, Oregonians for the first time can read his full, unfiltered account. read more »

11th Circ. Urged To Revive FCA Suit Against Helicopter Co.

Two whistleblowers Tuesday asked the Eleventh Circuit to revive their suit against MD Helicopters Inc. and a private equity firm over MD's unethical relationship with a U.S. Army project manager to overcharge for choppers, arguing MD's misrepresentations did in fact violate the False Claims Act.

U.S. District Judge Abdul K. Kallon in Alabama had tossed the suit in late March, ruling that the two former MD employees failed to show, as required by the FCA, that the Army’s payment of the contracts was conditioned on the company’s compliance with a Federal Acquisition Regulation section about reporting unethical conduct. 

But according to relators Philip Marsteller and Robert Swisher, that section has a mandatory reporting requirement. Had the government known that MD had no intention of complying with statutes and regulations against conflict of interest and bribery, all of which were incorporated as terms of the contract, the government would not have awarded the contracts to MD, the relators said Tuesday. read more »

5th Circ. Asks La. High Court To Define 'Good Faith'

The Fifth Circuit said Tuesday it wants the Louisiana Supreme Court to decide what the meaning of “good faith” is when someone files a whistleblower complaint under a state environmental law, in the case of a man who said he was fired for reporting alleged environmental violations by his employer.

Former deckhand Eric Borcik brought a whistleblower suit against his former employer Crosby Tugs LLC in 2013 under the Louisiana Environmental Quality Act, but a district court ruled in favor of Crosby, with a federal jury finding that Borcik didn’t report environmental violations “in good faith” as required by the act. Borcik said the district court erred in its judgment because it misinterpreted the meaning of good faith.

In Tuesday's unpublished opinion, the Fifth Circuit said that because the act itself does not define what good faith means, and because there is limited judicial guidance on the definition, it doesn’t want to speculate on its meaning. read more »