Written by Ellyn Sternfield and Stephanie D. Willis
In a Medicare Part C (or “Medicare Advantage”) False Claims Act settlement announced by the Milwaukee-Wisconsin Journal-Sentinel on September 25th, an operator of a Germantown Wisconsin Medicare Advantage plan and its parent agreed to pay $4.8 million to settle allegations that the company improperly paid eligible individuals to enroll in the Medicare Advantage plans, then misled them about the scope of coverage. The company was also alleged to have paid doctors for referrals of eligible individuals and enrolled some of the Medicare beneficiaries without their consent. The whistleblowers who filed the original False Claims Act suit in 2008 were a sales agent and a manager of the company that operated the Medicare Advantage plan. This case, like the November 2010 False Claims settlement involving a Florida Medicare Advantage plan whose owners allegedly exaggerated the severity of enrollees’ illnesses to increase reimbursements, shows that relators and their counsel are working with the government to establish causation between alleged business misconduct in health care settings and the submission of false claims.