Hochfelsen & Kani is looking for former and current employees of ResCare and its associates, who may have information about ongoing violations. We are in the process of investigating allegations of Medicare and Medicaid fraud.
The federal False Claims Act (“FCA”) and numerous state FCAs provide that insiders who come forward with information about Medicare and Medicaid fraud can receive substantial awards if they help stop fraudulent conduct. In fact, TRICARE fraud is also contemplated, and so is defrauding any other government-funded healthcare program.
In California, Medi-Cal fraud whistleblowers can be eligible for awards under the California False Claims Act. In California, tipsters who provide information about fraud against private insurers can also sue fraudsters under the state’s Insurance Fraud Prevention Act. Under these two types of legislation, whistleblowers are entitled to large cash awards.
False Claims Act whistleblowers can sue fraudsters on behalf of the government, which later decides whether to intervene or not. Even when the government declines, whistleblowers can still proceed with their fraud lawsuit. An experienced whistleblower attorney with the resources of an established firm can help you secure a favorable settlement or verdict. Under the FCA, whistleblower awards range between 15 and 30 percent of the total recoveries.
Louisville-headquartered ResCare Inc. is a health and human services provider operating in 42 U.S. states, Canada, and Puerto Rico. It employs 60,000 doctors and other workers. According to its website, ResCare “is dedicated to impacting communities for the better with a mission to help people live their best life. . . ResCare is the largest private provider of services to people with disabilities, the largest privately-owned home care company, the largest provider of specialized high-acuity neuro-rehab in community settings, and the largest career center workforce contractor in the U.S.”
Founded over four decades ago, ResCare provides a variety of daily living support and in-home care services to over two million people annually. The individuals serviced by the company include seniors, disabled adults, and children with special needs.
ResCare sounds wonderful on paper, but it is plagued by allegations of unethical behavior and poor service. Writing in an online forum, a cancer patient commented, “I'm dying of cancer. 8 months ago, I contacted ResCare Home Care to have in-home help once a week. ResCare was happy to take my credit card information and promised help in return. I am still waiting. . . I call, and every week it is a different excuse: "she's running late; she got lost”. . . I never met 'her.' I don't know her name. "She" doesn't exist. And yet, every month "she" charges my credit card for "her" services.”
“I am dying and I reached out to your company for help. Shame on you for treating the dying, the sick, the elderly in such a cold and heartless way. Your company is no better than any of the other scams out there that target the elderly,” the patient’s post concludes.
Indeed.com’s community ratings show ResCare’s employees’ opinions are not very positive either. In a review of the company, a former employee wrote, “Unprofessional. . . they care nothing about the individuals! The day center is also terrible! [They] leave individuals sitting in urine and feces!! A lot of internal investigations going on and the [caregivers] remain in the home! very poor staffing.”
ResCare was acquired by Canadian private-equity firm Onex Corp in 2010 and was rebranded as BrightSpring Health Services in 2018. The 45-year-old company aimed to reposition itself with a new name that “evokes and reflects optimism, compassion, innovative thinking and approaches and hope for the future.”
BrightSpring is now the parent company of a “house of brands” including ResCare HomeCare and ResCare Community Living. While it moved its headquarters to a new location in Louisville, the organization doesn’t seem to have changed much.
Onex valued ResCare at $390 million at the time of the purchase. For capital markets, a company that services mainly elderly or disabled Medicaid beneficiaries can be attractive. While the government should make sure Medicaid and Medicare reimbursements reflect the needs of each beneficiary, oversight deficiencies often make the likes of ResCare extremely lucrative and riddled with fraud.
ResCare/BrightSpring provides much needed services to elderly and disabled individuals, including vocational training, nursing, dementia care, home placement, and companionship. Some of the people it services live in assisted living facilities and nursing homes, but many receive care and assistance in their own homes. The company has also been providing telemedicine services for many years. In early 2019, it was sold to private equity firm KKR.
ResCare Billing Fraud Investigation - Medicaid Fraud
Our Medi-Cal fraud investigators are looking into ResCare’s billing practices. We have heard claims from beneficiaries and workers pointing to the company’s inappropriate billings for home and community-based services. In order for Medicaid to pay for these types of services, they must be approved by a doctor. These recommendations need to be re-assessed periodically.
When ResCare bills for services year after year without the appropriate periodic revaluations, this results in multiple False Claims Act violations. If a physician receives financial incentives to recommend expensive services, this also leads to false claims being submitted to the government.
It is rare that a patient should require the exact same type of care year after year. As some conditions may worsen, new ones may arise. This makes periodic certification a necessity. When health and human services providers focus on increasing Medicaid billings rather than ensuring transparency and quality of care, both patients and taxpayers suffer.
Another way that ResCare can defraud Medi-Cal is by billing for home care visits that never took place. In the example cited above, where a patient complained that nobody came to her house to provide care, ResCare could potentially have billed Medi-Cal for those non-existent visits.
As a company that services millions of individuals, ResCare has to ensure that tens of thousands of recertification visits take place every year. These visits are no simple thing. They require trained medical professionals, a thorough analysis of patient records, and a perspective on each individual’s progress. A care plan must be established for the next six-month or one-year period, and it must be approved by a doctor every single time.
We are investigating claims that some of these revaluations visits are not happening, and that staff may be simply filling forms with fabricated information to enable the company to bill Medicaid for high-cost services.
ResCare’s History of Fraud Investigations and Settlements
Over the years, ResCare has paid millions of dollars to settle allegations of billing schemes. In spite of its attempts to rebrand itself as friendly-sounding ‘BrightSpring,’ the company settled a fraud case as recently as October 2019.
ResCare Violations in New Mexico
In late 2009, allegations of New Mexico Medicaid fraud went all the way to jury trial. The verdict: ResCare had to pay $4.7 million in compensatory damages and $49.2 million in punitive damages. Though an Albuquerque court eventually reduced the punitive damages to $10.8 million, there was no hiding the egregiousness of ResCare’s violations of the Resident Abuse and Neglect Act. At the heart of the case was a disabled man who was raped on ResCare’s watch.
The victim’s name was Larry Selk. The lawsuit was filed by his sister and legal guardian, Rani Rubio, in Bernalillo County. The misconduct took place in one of Rescare’s facilities in New Mexico in 2004. The defendants were ResCare New Mexico Inc., ResCare Inc., and others.
Larry Selk was a resident at a group home in Roswell, which was operated by ResCare. He cannot speak and requires assistance to carry out the most basic daily functions. The jury found evidence that he was raped, most likely by a ResCare employee. The local police did not file a criminal case against the worker.
According to a spokesperson for the plaintiff, the man who raped Selk was hired after several employees were fired for drug use. Because ResCare needed new employees fast, it failed to carry out background checks that might have prevented the rape. In fact, the new hire had a record that would have made him ineligible for such a sensitive position. ResCare fought aggressively in court, but it failed on appeal, and it had to pay both compensatory and punitive damages.
ResCare Medicaid Fraud Cases in Texas
In 2005, ResCare paid $2.15 million to settle a Medicaid fraud case in Texas. According to a whistleblower’s allegations, Fort Worth-based The Citadel Group, a ResCare affiliate, falsified the date on certain documents in order to increase Medicaid billings.
The complaint referred to a common practice by Citadel Group employees: they allegedly billed Medicaid for patient visits when they were in fact enjoying parties among themselves. Over a significant period of time, the employees would do this every Friday. The practice, needless to say, resulted in patients receiving less care than they needed, and in fraudulent Medicaid billings.
The mental health care provider who filed the whistleblower lawsuit, Jennifer Hudnall, received an award amounting to hundreds of thousands of dollars. According to her claims, ResCare billed Medicaid for unrendered services, falsified patient records, and even billed pizza parties as if care were being provided to patients.
When health and human services providers make hundreds of millions of dollars every year, a few million lost in litigation here and there seldom acts as a sufficient deterrent for would-be fraudsters. And ResCare is not the exception. This is one of the reasons we need more whistleblowers to come forward.
ResCare Fraud Against Iowa Medicaid
In 2015, ResCare agreed to pay a $5.63 million settlement to resolve Iowa Medicaid and Medicare fraud allegations. The underlying False Claims Act lawsuit was filed by a whistleblower, who received between 15 and 25 percent of the total payout.
According to the Department of Justice, ResCare failed to complete annual assessments required to bill Medicare and Medicaid for home healthcare services. In Iowa, there is a requirement that an assessment must be carried out by a doctor face-to-face before an individual can be eligible to receive homecare services. Thus, if a physician has not made a visit to a beneficiary, billings for homecare provided to that beneficiary are fraudulent.
The whistleblower stated that from 2009 to 2014, ResCare Iowa was not in compliance with these rules, and yet proceeded to bill both Medicare and Medicaid for services provided to beneficiaries who had not been appropriately evaluated.
At the time, a spokesperson for the Office of the Inspector General stated, “Home health care providers that receive Medicare and Medicaid funds must abide by rules designed to ensure taxpayer funds are spent properly and that patients receive the appropriate care. . . We will continue to hold health care providers accountable for submitting improper claims.”
ResCare Neglect and Abuse in Indiana and California
ResCare/BrightSpring operates many group homes across Indiana. A Fishers resident named Anthony Harris, who lived at one of these facilities, experienced the darkest side ResCare.
Harris has cerebral palsy. He cannot speak and is completely disabled. He made headlines in 2017, when a ResCare employee admitted to having physically abused him, and shocking pictures of the victim’s severely injured face and body emerged.
The perpetrator was Michael Anderson, a caregiver who reportedly tortured Harris. Emergency room workers found the victim bloodied and bruised. According to a nurse, shortly after Harris’ arrival to the ER, another resident of the group home showed up, also severely beaten and bruised. A spokesperson for the victim referred to “the sheer magnitude of what was done to an absolute helpless person,” and the fact that he “had been tortured previously, his fingers had been bent back and broken.”
While Anderson went to jail, the case raised questions about ResCare’s personnel selection. In fact, it was later found that the perpetrator had prior convictions, including animal cruelty and drug abuse, and yet the company hired him to care for vulnerable patients. While he was employed at the Fishers group home, Anderson reportedly smoked marijuana on the job, but ResCare didn’t fire him. The victim’s family reached a confidential settlement with the company.
Thanks to a hidden camera, a 20-year-old severely autistic man who lived at a group home in California was rescued from another abuse situation at a ResCare operated home. Video of the man being attacked by a caregiver circulated online. It later became known that this perpetrator also had a prior history of violent behavior and assault charges. Before Rescare hired him, he had attacked a teenager with a knife. The case, filed in San Luis Obispo, was also settled confidentially.
When one considers that care provided by these violent individuals is being paid for with taxpayer dollars through Medicare and Medicaid, ResCare’s hiring practices, safety standards, and quality controls appear all the more shocking.
West Virginia ResCare - Sexual Abuse and Neglect Claims
While some ResCare patients have suffered abuse and neglect, others have even died due to the company’s negligence. After a teenager who lived in one of the company’s facilities in West Virginia lost his life, the public was made aware that local authorities had confirmed dozens of violations at ResCare’s WV group homes. From rape and assault to poor staff training and understaffing, the company’s clients were exposed to many forms of negligence and abuse.
A mentally disabled boy barely out of childhood, 13-year-old Jeremy Bush, was inexplicably allowed to leave Charleston’s Woodward Children’s Home on his own. He proceeded to take a vehicle from the facility’s parking lot and drove it till it crashed into a wall. The vehicle caught fire, and the boy burned to death.
Jeremy’s case might be the most egregious case of patients leaving ResCare homes, but it is not the only one. This type of negligence appears to be common at the company’s West Virginia facilities. One ResCare agency in Logan reportedly lost three clients in one year.
Training at some of ResCare’s West Virginia homes was so poor and staffing so insufficient, that emergency services were summoned 35 times to a single facility in Kanawha County over two years.
In 2016, a disabled girl fell and hurt herself several times, in her room and during van rides, due to negligence by ResCare staff. Employees of a ResCare facility in Beckley failed to prevent falls so often, that the girl eventually suffered brain damage and died as a result of the injuries.
In 2015, a ResCare employee sexually abused two clients at a Parkersburg facility. In 2016, a resident of a ResCare facility in Lewisburg reported that she had performed oral sex on one of her caregivers. In both instances, ResCare managers waited several days before informing the authorities. Employees who have raised concerns with supervisors about unsafe conditions and abuse at ResCare facilities in West Virginia have often faced retaliation.
In June 2019, an investigation by the state revealed that eight of ResCare’s Charleston clients had missed about 3,700 doses of medicine over a period of 90 days. The individuals had also missed medical tests and blood pressure monitoring. These findings led regulators to issue an order that temporarily banned new admissions and cut ResCare’s client cap.
If you are aware of violations taking place at a group home or nursing home operated by ResCare, talking to an attorney is the best course of action to stop the misconduct and protect vulnerable individuals.
Providing substandard care to Medicare and Medicaid beneficiaries is a violation of these programs’ rules. Understaffing, abuse, and insufficient training can all be grounds for a lawsuit against a health and human services provider.
ResCare Whistleblowers May Be Eligible for Cash Awards
Medicaid was created to provide quality healthcare to individuals who cannot afford it. Beneficiaries generally have no choice and must accept the treatment offered by a designated provider. Unscrupulous Medicaid and Medicare providers take advantage of this situation to perpetrate fraud all over the U.S., often putting beneficiaries at risk by focusing on profits rather than medical necessity.
Regulators rely on whistleblowers to expose Medi-Cal fraud. In California and beyond, the government lacks the resources to monitor providers’ suspicious activities, and most fraud investigations are initiated by courageous tipsters with the help of an established whistleblower attorney.
Medicaid and Medicare providers often misrepresent the truth to secure unauthorized benefits. Common types of misconduct include filing claims for services never rendered, falsifying records, overbilling, reporting false diagnoses to ensure higher reimbursements, and billing for services provided to ineligible patients.
Whistleblower legislation is the most efficient tool for exposing Medicaid abuse. In the case of providers operating nursing homes and group homes, like ResCare, beneficiaries can be at a high risk of neglect and abuse. Medicaid can only reimburse companies for quality care, and when vulnerable individuals are subject to substandard care, this also constitutes fraud.
The False Claims Act provides that whistleblowers can receive between 15 and 25 percent of any recoveries resulting from an FCA lawsuit. Because health and human services providers often service millions of individuals, the number of violations tends to be very high, resulting in many multimillion-dollar awards for whistleblowers.
The government has recovered billions of dollars since it decided to crack down on providers who defraud Medicare and Medicaid, leading to whistleblowers receiving hundreds of millions of dollars in rewards.
To be eligible for an award, Medicaid and Medicare whistleblowers must file a quit tam lawsuit against wrongdoers on behalf of taxpayers and the government. If they don’t file a qui tam or FCA lawsuit, whistleblowers may miss out on substantial rewards. Calling a government hotline to report fraud is not enough to ensure there will be a government investigation. Regulators take cases more seriously when an appropriate FCA lawsuit has been filed with the help of a whistleblower attorney.
Calling ResCare/BrightSpring Whistleblowers
If you are a ResCare/BrightSpring insider with information or suspicions about Medicaid or Medicare fraud, you can contact us confidentially. We can likely help you expose fraud, protect beneficiaries, and recover taxpayer funds. Because it is not easy to speak out about corrupt health and human services providers, the U.S. and most states have implemented legislation to encourage whistleblowers by offering large cash awards.
If you are a current or former employee of ResCare or one of its affiliates, and have information about Medi-Cal, Medicare, or Medicaid fraud, contact us today for a free consultation. If your case has merit, our whistleblower attorneys will work with you to maximize recoveries and expose wrongdoers.
Our team of investigators and expert witnesses can quietly gather the evidence to build a solid case against dishonest providers and secure the maximum whistleblower awards. We have recovered tens of millions of dollars for the U.S. and the state of California, and several of our clients have received multimillion-dollar awards. All inquiries are confidential and subject to the attorney-client privilege.