I don’t know why, but I just love it when big corporate powers get hammered. Maybe you don’t read the Chicago Sun Times newspaper or keep up with Qui Tam based fraud nationally, but if you do then you know that last week an Illinois HMO was hit with a $334 million dollar judgment. This is the largest fraud verdict in the history of Illinois.
The beauty of the judgment is that not only did the company get hit with a $144 million dollar judgment but they were also slapped with a huge penalty by the Judge. God Bless him for using the law to correct bad behavior. Everyday huge corporations laugh at the anti fraud laws and say to themselves, “we are above the law, even if we are caught, we will tie this thing up forever in court and when the chips finally fall we will “negotiate” out of paying any penalty and just pay back what we defrauded our great nation. “ Be warned, if you end up in Judge Leinenweber’s court, he is going to properly punish your company for fraud.
The company is called Amerigroup and they were caught by one of their own former vice presidents, Cleveland A. Tyson. I am sure that Amerigroup has nothing good to say about Mr. Tyson, but at this point, Mr. Tyson is entitled to a large cut of the $334 Million dollar total judgment. Even at the statutory minimums, (15%) he is going to be a wealthy man and our tax dollars are being refunded.
Amerigroup claims they are completely innocent of defrauding Medicaid. They feel they have enough to appeal the judgment. What did I say about companies tying things up in court?
The great thing about Qui Tam is that, although, this case is the biggest in its jurisdiction, according to the Chicago Sun Times, it is only the 5th largest judgment for the past year. There are 4 other cases that have larger verdicts. Isn’t that delightful, that huge repayments of fraud money are going back to the people? Well at least it is split between the people (tax payers) and the whistle blower (Relator) in a fair percentage. One word of warning about Qui Tam cases. They are not easy. Attorneys for the Amerigroup whistleblower (Relator) spent about 25,000 attorney hours. They are true champions of justice. They, along with the whistle blower, took a huge risk and made their good work count. Now, they will need to survive the appeal.
Can you believe that Amerigroup has moved out of Illinois? What a shame? I wonder if Amerigroup is facing such troubles in any of the other 10 states they conduct business?
What did Amerigroup do, you ask? They defrauded Medicaid by taking federal money and then not following the rules. Amerigroup did not want to insure pregnant women. They set up a system to exclude those people from their HMO. That makes sense, doesn’t it? Why insure people who will need medical care, regardless of what the law requires? HMOs want to charge a premium and accept Federal money to insure people who will not need medical care. Who else other than people with health risks are actually on Medicaid. Isn’t that the point of the system, to help the people at risk?