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Medicare fraud whistleblower gets $631,200 from Fresno County jury

A Fresno County jury has awarded more than $600,000 to a respiratory therapist who said she was wrongfully terminated at a sleep medicine center because she blew the whistle on Medicare fraud.

Tansi A. Casillas, 51, of Fresno, alleged that her employer, Central California Faculty Medical Group, eliminated her position at University North Medical Specialty Center in retaliation for the fraud complaints she made and for refusing to perform medical services outside the scope of her respiratory care license.

In her lawsuit, Casillas said doctors left the responsibility to her to have face-to-face evaluations with patients on continuous positive airway pressure, a treatment that keeps the airways open for people who have sleep apnea and other breathing problems. The patient and Medicare were later billed for a doctor’s visit, even though the patient was not seen by a doctor, the lawsuit said.

Central California Faculty Medical Group is a multispecialty practice affiliated with UCSF-Fresno. It operates several medical offices, including University North Medical Specialty Center for pulmonary and sleep medicine.

According to the lawsuit, the faculty medical group’s compliance department investigated Casillas’ claims and found the medical group had “erroneously” overbilled Medicare but that no fraud had occurred. The overbilling resulted in the medical group’s reimbursing Medicare for the overcharges, the lawsuit said.

On Oct. 27, the jury found Casillas had been retaliated against for being a whistleblower and awarded her $131,200 in economic and emotional damages. On Oct. 28, they awarded her $500,000 in punitive damages.

We respect the jury’s decision; however, we are in the process of evaluating a possible appeal.

Karen Rushing, human resources director for Central California Faculty Medical Group

Karen Rushing, human resources director for Central California Faculty Medical Group, said in an email Wednesday that the medical practice strongly denied wrongdoing.

“We respect the jury’s decision; however, we are in the process of evaluating a possible appeal,” Rushing said. “CCFMG works hard to assure regulatory compliance throughout our organization. At this time we are unable to comment further.”

The faculty medical group, represented by San Francisco lawyer Steven R. Blackburn, argued in a motion to dismiss the case, saying that Casillas was terminated for economic reasons that were aggravated by “her bad behavior in interacting with her coworkers.”

The faculty group said Casillas had used her job to unethically make referrals to a durable medical equipment company to benefit her husband, who was an employee there. She became upset when the director for sleep medicine would not forge a doctor’s note for a Medicare audit of the equipment company, according to the defense motion. “After that, she loudly and repeatedly cast herself as a ‘whistleblower,’ ” the motion said.

According to Casillas’ lawsuit, the medical group falsely accused her of violating the company’s conflict of interest policy as part of its retaliation for being a whistleblower.

Casillas had worked as a respiratory therapist for the faculty medical group since November 2008 and had received good performance evaluations before her whistleblowing, the lawsuit said. But she worked under a “microscope” after she refused to perform medical services outside the scope of her respiratory care license and refused to participate in unlawful billing to Medicare, the lawsuit said.

She first voiced concerns about Medicare fraud to Dr. Lynn Keenan, medical director for sleep medicine at North Medical Specialty, on April 8, 2013, the lawsuit said. Concerned that the issue had not been taken seriously, she called the faculty medical group’s compliance officer and the National Board of Respiratory Care on April 9, 2013.

She just busted into tears after the verdict.

Parnell Fox, lawyer for Tansi Casillas

The following day, retaliation began, the lawsuit said.

The faculty medical group claimed her termination was for economic reasons, but she had been made a full-time employee in April 2012 because her position was profitable to the company, the lawsuit said.

Her position was terminated on Jan. 3, 2014.

The jury found that Casillas’ disclosure about Medicare fraud and her refusal to participate in medical services outside the scope of her respiratory care license were contributing factors in the faculty medical group’s decision to discharge her. And the jury found the medical practice would not have discharged her for legitimate, independent reasons.

Visalia lawyer Parnell Fox, who represented Casillas, said she found employment after being fired but at a lower rate of pay. The family had to use money from savings to survive. “They made it through, so she should be OK,” Fox said.

Casillas felt the jury “heard her voice loud and clear that patient care matters,” Fox said. “She just busted into tears after the verdict.”

Barbara Anderson: 559-441-6310, @beehealthwriter

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