Whistleblower resigns, stressed over nursing home's alleged Medicare fraud. $1.2M. Los Angeles County.

Facts and Background

• Facts and Background:

  Malissa White, an African-American woman, was employed as a nurse by Rockport Administrative Services to provide services at Country Villa South from March 2018 until May 13, 2019. She was promoted to the role of a Minimum Data Set “MDS” Nurse in August 2018. In that role, she was responsible for assessing all residents in Medicare to report a standardized assessment of each resident’s health needs to Medicare. She resigned her position in May 2019.

• Plaintiff's Contentions:

  That plaintiff witnessed, reported and was expected to participate in illegal activity by her employer. That the ongoing stress of this employment situation and retaliation by her supervisor caused emotional distress, resulting in constructive termination.

  Plaiintiff alleged that she enjoyed the first several months of her employment as an MDS Nurse. However, that beginning February 2019, she began witnessing illegal activity performed by others at the facility.

  As the MDS Nurse, plaintiff had a heightened duty to ensure that the information being submitted to Medicare was accurate and truthful. Plaintiff was therefore shocked to discover that the facility regularly admitted Medicare patients using “Certification and Recertification - Extended Skilled Services” forms that were pre-signed by a doctor and otherwise blank, and that staff at Country Villa South joked about submitting fraudulent forms in group “WhatsApp” texts by saying that they obtained the physician’s pen so the fraudulent submissions could look more realistic.

  Plaintiff claimed that she was also asked to falsify IDT plans, Medication Administration Records, and saw others doing so as well. Further, that she was also encouraged to increase the level of acuity, or the Resource Utilization Group, for some of the Medicare patients, all in an effort to collect improper fees from Medicare.

  Plaintiff first reported these violations to CDPH investigator Robin Edmond anonymously via email on February 21, 2019 and then again on March 7, 2019. She claims that she complained internally to corporate compliance about these issues and that she emailed copies of the pre-signed blank certifications to Jeremy Shelton at Rockport’s human resources department.

  After these initial reports were made, plaintiff says that her supervisor, DON Danielle Jarrett, began to treat her differently and got angry at her for several insignificant matters. That DON Danielle Jarrett once made a derogatory comment during a class regarding the fact that plaintiff’s husband is Muslim, asking plaintiff if she “wraps up” her head like other wives of Muslim men. DON Jarrett allegedly wrote up plaintiff for not clocking out when plaintiff acted as the manager on duty, even though there was a clear written policy that plaintiff did not need to clock out while acting in that role.

  Plaintiff reported the retaliation to Jeremy Shelton on March 29, 2019. Plaintiff felt like she was in the middle of a Medicare fraud scheme.  She was told on several occasions that “this happens all the time.” At the end of the month in April, during the “Triple Check Meeting” plaintiff was present when a billing consultant said “this is not the doctor’s signature” on one of the forms submitted to Medicare that is used to admit a patient. The stress became too much for plaintiff to handle, and she resigned on May 13, 2019.

• Defendant's Contentions:

  Defendants consistently claimed that they had no knowledge of anything criminal such as Medicare fraud at Country Villa South.