Centra Health Inc. was sued in the Western District of Virginia today by their former employee, John-Paul Neblett, for retaliation. The plaintiff alleged that Centra violated the False Claims Act by firing him for attempting to report millions of dollars of Medicare and Medicaid overpayment.
Centra is a nonprofit organization that owns and operates acute care hospitals, long-term care facilities, and other health care-related facilities and companies in Virginia, the complaint said. Medicare and Medicaid can be used to pay for treatment. Under the Affordable Care Act, overpayments can occur for a “variety of reasons, including fraud, mistake and negligence,” and there is a 60-Day Overpayment Rule that states “any ‘overpayment’ must be returned within 60 days of being ‘identified.’” Furthermore, “any overpayment failed to be reported to Centers for Medicare and Medicaid (CMS) and retained after the 60-day deadline is a violation of the False Claims Act.”
The plaintiff worked in the credentialing department of Centra for several months, with “over fifteen years of credentialing related experience” and “became aware of fraudulent activity at Centra.” He alleged that he became aware that “Centra knowingly falsified provider eligibility documentation required by government programs, including Medicare, Medicaid, Tricare and other federally and state funded healthcare programs.” Centra allegedly trained Neblett to “cut provider signatures from signed and undated CMS forms and paste them on Medicare [and other government] enrollment applications and state-required paperwork,” with the plaintiff supposedly observing “thousands” of faked forms being made.
Neblett brought his concerns to his supervisors, human resources and his compliance officer in January 2019. An internal investigation was supposedly conducted and Centra promised to stop this practice immediately; however, they allegedly still “continue these practices to this day” and may owe over $5 million in overpayment. Though Centra “thanked” him for his complaints, he was fired, supposedly in retaliation, one month later. The plaintiff claims that the False Claims Act “prohibits the discharge […] against an employee for done by the employee on behalf of the employee or others in furtherance of an action under the FCA,” suing on one count of retaliation.
John-Paul Neblett is seeking damages for loss of pay from the retaliation, interest, litigation costs, expenses and attorney’s fees and costs.