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.