The need

Attorneys representing a whistleblower in a false claims act suit against a home health agency needed an expert in nursing to make their case. The suit alleged that the defendants fraudulently billed Medicare for services that were not actually provided. As such, the expert would need to be able to analyze patient records. Given that, the ideal expert would be a nurse formerly employed by the defendant.

Our approach

From conversations with the client, we knew they had trouble finding experts that had worked for the defendant because of confidentiality agreements they had signed. Therefore, they would accept nurses or nurse managers from other agencies who understood home health patient records and Plans of Care. This in mind, we went to work to find the precise fit.

The expert

We found an expert with almost 40 years of experience as a board-certified Family Nurse Practitioner and a Registered Professional Nurse. She had significant experience in Home Health Care including working for the defendant over a period of 10 years. In her career, her responsibilities included supervising and instructing home health workers in the plans of care, and she had extensive experience with standards of care, plans of care and medical record review. In addition to practicing nursing, she had been an Assistant Professor of Nursing and a Clinical Instructor at top nursing schools. Well respected in her field, she was a frequent presenter and mentor for graduate nursing students and was a published author on healthcare issues. Additionally, she was an experienced Certified Legal Nurse Consultant and had testified previously. The suit was successfully resolved with a large settlement for the plaintiff.