Dr. Jean Moore, a physician, will receive an $825,000 whistleblower reward for reporting that his employer, a hospital and an affiliated medical clinic, submitted false claims to Medicare. The hospital and affiliated clinic have agreed to pay $5.5 million to settle the claims.
Dr. Moore alleged that the hospital and its affiliated clinic were paying bonuses to physicians in return for patient referrals. The bonuses were paid based on a formula that took into account the value of the physicians’ patient referrals.
Paying anything of value in return for referrals of Medicare patients violates the anti-kickback statute. It also renders all resulting claims to Medicare “false claims” for purposes of the False Claims Act.
Dr. Moore started a qui tam or whistleblower lawsuit under the False Claims Act. That law allows individual citizens to commence a lawsuit on behalf of the government for false claims submitted to Medicare, Medicaid, and other government programs. The lawsuit is filed “under seal” (in secret), and the whistleblower provides all of his evidence to the government. The government then investigates the claims.
If the government recovers money as a result of the qui tam lawsuit, then the whistleblower is entitled to a reward of between 15% and 30% of the amount actually recovered.
The key to a successful whistleblower lawsuit is having evidence of the false claims. It is not enough that you suspect that false claims are being filed. You must give the government evidence to support your suspicions.
If you have evidence that a healthcare provider is paying kickbacks in return for patient referrals, or that it is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately. You may be entitled to a substantial reward and legal protections as a whistleblower.
You may not file a whistleblower lawsuit on your own. The law requires that an attorney file the lawsuit for you. You will also need careful legal advice on gathering and presenting your evidence, especially if HIPAA-protected medical records are part of your evidence.
Contact our law office for a free and confidential consultation. If you have a case, we will represent you on a contingency fee basis. You will not owe any legal fees unless you win.
John Howley, Esq.