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Orlando nursing center, surgeon pay $1.5 million to settle lawsuit

Lawsuit filed by former employee alleged fraudulent Medicare practices

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(Associated Press)

ORLANDO, Fla. – An Orlando rehabilitation center and orthopedic surgeon have agreed to pay a collective $1.5 million to resolve a lawsuit that alleged the health care facility and doctor violated federal law through its fraudulent Medicare practicares, according to the Morgan & Morgan whistleblower team.

Morgan & Morgan represented Jonathan Montes de Oca, a former employee of Conway Lakes Health & Rehabilitation Center, in a lawsuit that said the rehab paid physicians to serve as medical directors and physician advisers to allow them to refer patients to nursing, rehabilitation and at-home health services.

According to Berger Montague, a commercial litigation and class-action law firm, the Anti-Kickback Statute "prohibits any person or entity from offering, making, soliciting, or accepting remuneration, in cash or in kind, directly or indirectly, to induce or reward any person for purchasing, ordering, or recommending or arranging for the purchasing or ordering of federally-funded medical goods or services."

The law firm also states Stark Law "prohibits physicians from referring patients to receive designated health services payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies."

Whistleblower attorney James Young and lead investigator Lee Walters, who is a retired FBI special agent, worked with the whistleblower team to gather evidence and build a case to expose the alleged fraud. In addition, agents from the U.S. Department of Health and Human Services and Jeremy Bloor, of the Association of the United States Army, worked to determine the full extent of the alleged fraudulent scheme.

“Mr. Montes de Oca was able to show us how the fraudulent scheme was set up and provide us with important documentation to support his allegations,” Walters said. “Without Mr. Montes de Oca, this scheme would have never been discovered and would still be costing the taxpayer untold amounts of money and robbing patients of the ability to choose the best option for their health care.”

Young said when de Oca was hired at the facility, he began to question relationships between various physicians and, over time, realized they were violating federal law. 

The lawsuit was filed by de Oca under the whistleblower provision of the False Claims Act, which allows individuals to sue on behalf of the government over false and fraudulent claims and for the federal government to intervene, which it did for this lawsuit, according to Morgan & Morgan officials.

“This case relied on information known to very few people, and fortunately, our client was brave enough to speak out about what the defendants were doing was wrong,” Young said. “The government would not have discovered this during a routine audit, as documentation had been falsified to make it appear as though the financial relationship between the defendants was proper. The sad reality is that fraud is everywhere in health care. All it takes is people brave enough to speak truth to power and expose these schemes."