Every day, the government announces another multi-million dollar Medicare or Medicaid fraud settlement. Today there was not one announcement, but three.
First, a Johnson & Johnson subsidiary agreed to pay $18 million to settle claims that it caused physicians to submit false claims to Medicare by marketing a medical device for use as a drug-delivery device for prescription corticosteroids, when that use was not approved by the FDA. Second, a hospital in South Carolina agreed to pay $17 million to settle claims that it submitted false claims to Medicare and Medicaid, and that it provided financial incentives to doctors for patient referrals. Third, a diagnostic imaging company agreed to pay $3.5 million to settle claims that it billed Medicare and Medicaid for services that were provided without adequate supervision. Three settlements. Almost $40 million. All announced in just one, typical day in the healthcare fraud arena. Why is there so much fraud in Medicare and Medicaid? Because the government cannot find fraud without help from insiders. Medicare and Medicaid receive more than 1 million claims for reimbursement every day. There is no way for the government to know whether each of those one million claims involved services that were medically necessary, or were properly supervised, or were billed using the proper billing code and not a code for a more expensive procedure. That is why the government relies on – and rewards – whistleblowers who come forward with evidence of fraud. In the South Carolina hospital case, for example, the government began its investigation only after a physician who worked for the hospital came forward with evidence of improper billing and financial incentives. Now that doctor will receive a whistleblower reward of between 15% and 25% of the amount recovered – which will be somewhere in the range of $2.5 million and $4.25 million. If you have evidence that a healthcare provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to legal protections and a substantial reward. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Do not delay. There are strict time limits and procedural requirements to qualify as a whistleblower.
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A former billing manager for Pharmasan Labs, Inc. will receive more than $1 million as a whistleblower reward for reporting false Medicare claims for lab tests.
The former billing manager initially raised concerns about false billing with the company’s management. When they did not respond, he filed a whistleblower lawsuit under the qui tam provisions of the False Claims Act. The False Claims Act allows individuals to start a lawsuit “under seal” (i.e., in secret) on behalf of the government for false claims submitted to Medicare and Medicaid. The government is required to conduct an investigation before deciding whether or not to pursue the lawsuit. If the government recovers money as a result of the lawsuit, then the whistleblower is entitled to a reward of between 15% and 30% of the amount recovered. In this case, the government investigated the whistleblower’s claims that Pharmasan submitted false information for laboratory services billed to Medicare and improperly sought reimbursement for services referred by non-physician practitioners. Pharmasan agreed to settle the lawsuit for $8.5 million. The settlement resolves claims that it falsely billed Medicare for ineligible food sensitivity testing and submitted false information to Medicare concerning the nature of the tests. The settlement also resolves claims that its patient referrals for laboratory services came from non-physician practitioners who were not eligible to refer Medicare paid services. If you have evidence that a healthcare provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be eligible for a substantial financial reward and legal protections as a whistleblower. To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. Whistleblowers Alleged Millennium Laboratories Submitted False Claims to Medicare and Medicaid for Unnecessary Drug and Genetic Testing
A group of whistleblowers will share more than $31 million in rewards as part of a settlement of claims that Millennium Laboratories billed Medicare, Medicaid and other government healthcare programs for unnecessary urine and genetic testing. The whistleblowers also alleged that the laboratory company gave free supplies to physicians in return for patient referrals. The whistleblowers alleged that the lab company promoted so-called “custom profiles,” which effectively created standing orders from physicians for large numbers of lab tests without an individualized assessment of each patient’s needs. These standing orders allegedly resulted in Medicare and Medicaid paying for urine and genetic tests that were not medically necessary for the diagnosis and treatment of an individual patient’s illness or injury. The whistleblowers also alleged that the lab company provided physicians with free urine drug test cups, but only if the physicians agreed to return the urine specimens to the lab company for lab testing. The Stark Law and the Anti-Kickback Statute generally prohibit laboratories from giving physicians anything of value in exchange for patient referrals. The lab company agreed to settle these allegations by paying $256 million. Of that amount, the whistleblowers will receive more than $31 million in rewards. The lawsuits were filed by current and former employees, competitors, and private insurance companies under the qui tam or whistleblower provisions of the False Claims Act. A qui tam lawsuit is filed by a private individual or entity on behalf of the government to recover money paid by the government for false claims. The qui tam suit is initially filed “under seal” (i.e., in secret), and the whistleblower’s evidence is provided to the government. After conducting an investigation, the government decides whether to pursue the case. If the government recovers money as a result of the qui tam lawsuit, the whistleblower is entitled to a reward of between 15% and 30% of the amount the government actually recovers. If you have evidence that a lab company or healthcare provider has submitted false claims to Medicare or Medicaid, then you should consult with an experienced healthcare fraud whistleblower lawyer immediately to protect your rights. You may be entitled to a substantial reward and legal protections as a whistleblower. To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. A receptionist in a physician’s office is in line to receive a six-figure whistleblower reward after her employer agreed to pay $1.1 million to settle claims that it billed for unnecessary medical testing.
Rosemarie Hennessey, a receptionist at East Islip Family Care, filed a complaint on behalf of the United States government under the qui tam or whistleblower provisions of the False Claims Act. She alleged that her employer and its physicians ordered diagnostic tests on patients that were not medically necessary. The physicians and the practice group then billed Medicare for the unnecessary tests. The tests at issue are called nerve conduction studies or NCVs. NCVs involve the electrical stimulation of a patient’s nerves and muscles to measure the conduction speed of electric impulses and proper nerve and muscle function. Because NCVs involve the administration of low levels of electric current to a patient, the tests can be uncomfortable and even painful. The whistleblower alleged that the physicians ordered NCVs despite the lack of apparent indications in the medical charts. She also alleged that even when NCV studies were indicated, they were not performed properly. For example, patients with arm complaints were given NCVs on their legs. The whistleblower claimed (and the government agreed) that the physicians were billing for tests that were not medically necessary. Under the False Claims Act, an individual with evidence of false claims to Medicare or Medicaid may file a complaint on behalf of the government. The complaint is filed “under seal” (that is, in secret), and the evidence of false claims is provided to government prosecutors. The prosecutors then conduct an investigation to determine whether or not to pursue the lawsuit. If the government recovers money as a result of the lawsuit, the whistleblower is entitled to a reward of between 15% and 30% of the amount recovered. After conducting an investigation in this case, the government decided to pursue the claims and negotiated a settlement with the physician and his practice. Dr. Vikas Desai, the principal of East Islip Family Care, and Dr. Robert Maccone, a physician who was previously affiliated with the practice, agreed to pay the United States a total of $1,120,299 to resolve the allegations that they submitted claims to Medicare for NCVs that were not medically necessary. The amount of the whistleblower’s reward has not yet been determined. Based on the statute, she should receive between 15% and 25% of the amount the government actually recovers from the defendants. If you have evidence of false or inflated claims to Medicare or Medicaid, you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to a significant reward and legal protections as a whistleblower. John Howley, Esq. (212) 601-2728 |