In September, 2004, New Jersey Medicaid recipient Richard West, 63, who was diagnosed with Muscular Dystrophy in 1981, learned that his Medicaid home healthcare services would be reduced or suspended to make up for services he had already received that exceeded his monthly limit.
West had been keeping a log of his home care and knew he had not exceeded his limit. To oppose the suspension of his services, he examined his day planner and time records of the home health care nurses and came to the conclusion that the home health care provider had billed Medicaid for services he never received.
After conferring with False Claims Act attorney Robin Page West (no relation) of Baltimore, MD, Mr. West alerted the federal government to the suspected fraudulent billings, and later that year filed a “qui tam” whistleblower lawsuit alleging, among other things, that from April 2003 to July 2004, Medicaid was billed for approximately 735 hours of services that were not provided to him.
“I never took any benefits I wasn't qualified for,” Richard West said. Then to find out I was losing services I needed to stay in my own home, because the government was being billed for services I never received-- that was not going to happen!”
The lawsuit triggered federal and state investigations that culminated in September, 2011 in a $121 million settlement, of which approximately $14.8 million will be paid to West as his “relator share” of the recovery.
West acknowledged that working with government investigators to prove the fraud has been both gratifying and grueling.
“From my wheelchair on a ventilator and oxygen, I have spent the last seven years in this fight. Sometimes the good guys win. Anyone who suspects fraud needs to speak up; it's the right thing to do! I am very grateful to the many state and federal prosecutors and investigators who have worked so doggedly on this case. The government needs to know about fraud in order to stop it. I am willing to work for my country, the USA, by blowing the whistle, and this settlement makes it clear that my country is there for me as well,” the foreign war veteran said.
Mr. West operates Able West, Inc., a non-profit 501c3 corporation serving the New Jersey Shore disabled community since December of 2005. Able West, Inc. promotes education for quality of life, support for community inclusion, and advocates for assistive technology for people with disabilities. It is best known for the annual Richard West 5 mile wheelchair race in June and an accessible fishing trip in the fall.