Overview
Cohen Milstein represents the relator, Leslie Carico, a whistleblower, in a qui tam lawsuit on behalf of the United States of America against Veterans Guardian VA Claim Consulting, LLC and Scott Greenblatt, co-founder and CEO of Veterans Guardian, William Taylor, co-founder and COO of Veterans Guardian, and Gregory A. Villarosa, Ph.D., for violations of the federal False Claims Act (FCA).
Ms. Carico, a former disability benefits application specialist at Veterans Guardian, claims that the defendants conspired to submit thousands of fraudulent mental health disability claims to the U.S. Department of Veteran Affairs (VA). Indeed, Ms. Carico, who oversaw these applications, claims that Veterans Guardian’s business model of providing veterans pre-filing consultation services to increase their monthly VA disability payments is wholly grounded in fraud. Essentially, Veterans Guardian would screen for veterans with pre-existing health conditions involving chronic pain syndrome and would diagnose them with a secondary, related mental disability that purportedly arose from their military service to obtain a 100% Permanent and Total level of disability, regardless of whether they actually suffer with such disability. In the event that Veterans Guardian failed to induce the VA to assign 100% of this disability level, the defendants allegedly resubmitted the application with another sham diagnosis.
As a consequence, the government has been deceived into paying millions of dollars in unwarranted disability payments, a generous portion of which goes directly into the pockets of Veterans Guardian and, in turn, the company’s owners, Greenblatt and Taylor.
Case Background
Since 2017, Veterans Guardian has provided veterans with “prefiling consulting services” to allegedly help eligible veterans increase their monthly VA disability payments.
Ms. Carico claims that Veterans Guardian’s business practices are wholly grounded in fraud.
Co-founded by Scott Greenblatt, the CEO, and William Taylor, the COO, the operation of Veterans Guardian and the alleged fraud have been run in close collaboration with Dr. Villarosa, a physician who oversees a team who conducts the veterans’ psychological examinations and prepares false medical records to enable and cause Veterans Guardian to submit false claims to the VA. Notably, some of Dr. Villarosa’s team lack the educational and clinical background mandated under federal law to conduct these exams.
Veterans Guardian promotes its services nationwide by Facebook, its website, referrals, gun shows, and a national team of recruiters, among other means with a singular focus on getting veterans assigned to the 100% Permanent and Total level of disability.
Allegedly, Dr. Villarosa plays a key role in this fraudulent scheme. He works to ensure that for each client Veterans Guardian refers to him or one of his subordinates, he provides Veterans Guardian a completed mental health disability benefits questionnaire which, as he understands, is eventually submitted to the VA by Veterans Guardian to apply for mental health disability benefits. In exchange, Dr. Villarosa receives a fee engineered by Veterans Guardian for each of these completed fraudulent mental health forms because the veteran is required to pay $295 directly to Dr. Villarosa for the consultation.
Dr. Villarosa and Veterans Guardian carefully prep the veteran for examination. The documentation which Dr. Villarosa prepares (and indeed all the documentation that comprise the packet of materials defendants submitted to the VA), is largely auto-populated with diagnoses and symptoms.
Veterans Guardian finds a mental disability, typically depression disorder due to chronic pain syndrome, with each of its veteran clients, claims it is secondary to the veterans’ pre-existing disabilities and arose, at least in part, from military service. Defendants rely on the diagnosis of a mental disability to obtain a 100% Permanent and Total disability level for each veteran regardless of whether the veteran even has a psychologically based disability and regardless of the extent of any such disability.
According to Ms. Carico, the disability level assigned to the patient by the examiner is never below 50%. Ever.
Once approved by the VA, Veterans Guardian takes a commission calculated as five months’ worth of the increase in the veteran’s monthly disability payment.
In the event that Veterans Guardian fails to induce the VA to assign the 100% Permanent and Total disability level defendants pursued with its initial submission, the company routinely proceeds to tack on another diagnosis, such as erectile dysfunction, and then resubmit the application. Like the mental diagnoses, there is no clinical support for these supplemental diagnoses. Veterans Guardian simply informs the client of the addition, adds the supplemental diagnosis, and resubmits the claim. Using a four-person team composed of two certified nursing assistants and two employees with no background in providing health care, a disability is designated based solely upon physical symptoms the veteran previously complained about.
If a disability claim is denied, Veterans Guardian appeals it. In Ms. Carico’s experience, Veterans Guardian’s appeals enjoy a success rate approaching 99%.
While perpetrating this fraud on the VA, Ms. Carico claims that Veterans Guardian expanded its fraudulent practices by submitting false claims to the Small Business Administration to obtain a loan under the Paycheck Protection Program
Case name: U.S. ex rel. Carico v. Veterans Guardian VA Claim Consulting, LLC, et al., Case No. 20-784, United States District Court for the Middle District of North Carolina