ATTORNEY NEWSLETTER
Kickbacks Alleged In The Form Of Meals, Sporting Events And Lavish Trips
Former Employee Blew Whistle
How Qui Tam Cases Work
Healthcare providers in the U.S., including sellers of medical products and devices, hospitals and clinics, are subject to a number of statutes to prevent any fraudulent billing under government programs like Medicare and Medicaid. One important such law is the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b, which prohibits kickbacks to physicians for patient referrals for services covered by Medicare and Medicaid (known as Medi-Cal in California). When the providers violate the Anti-Kickback Statute or certain other federal healthcare laws, they also violate the False Claims Act (“FCA”), 31 U.S.C. §§ 3729-3733, for submitting false claims for payment to the government. One of the underlying protections against fraud in the healthcare field is Individuals with information about this kind of scheme can be rewarded for bringing this kind of illegal practice to light. 31 U.S.C. § 3730(b). The California whistleblower attorneys at Evans Law Firm, Inc. represents individuals who bring FCA cases based for any kind of fraud against Medicare or Medicaid or other government-sponsored healthcare programs. If you have credible, original information of healthcare fraud, call us today at (415)441-8669 or toll-free at (888)-50EVANS (503-8267) and we can help.
Anti-Kickback Case Settlement
According to a recent U.S. Department of Justice (DOJ) press release,[1] a medical imagining company and its owner will pay the United States and the State of Georgia $5,250,000 to resolve allegations that they violated the False Claims Act by: (1) providing physicians with meals, tickets to sporting events, and other gifts to induce those physicians to refer diagnostic scans to the company’s independent diagnostic testing facilities; and (2) entering into above fair market value personal services agreements with referring physicians to induce those physicians to refer scans to them.
The government alleges that, between 2011 and 2019, defendants relied on a variety of inducements – sporting events, fishing trips, happy hours, sponsorships of “open houses” at physician offices, and gifts of alcohol, gas cards, and free scans – to generate referrals for diagnostic scans. Many of the company’s marketing events, according to the government, involved no discernible educational purpose. Examples include tickets to the SEC football championship game, tickets to concerts, monthly dinners with referral sources, and outings to nail salons. The government also alleges that the company entered into personal services agreements with referring physicians that were above fair market value. Under these agreements, physicians were compensated to interpret the scans that they referred to defendants.
The settlement resolves allegations filed by a former employee, who will receive a share of the settlement.
How False Claims Act Whistleblower Cases Work
Cases such as this one are often initiated under the qui tam, or whistleblower, provisions of the FCA. 31 U.S.C. § 3730(b). The FCA allows private parties to sue on behalf of the government for false claims, and to receive a share of any recovery. 31 U.S.C. § 3730(b) (procedures for initiating qui tam actions). The suit is filed confidentially and remains under seal giving the government time to review the allegations in the case. If the government decides to intervene, the government essentially takes over the case. If the government declines to intervene, the plaintiff has the right to continue the suit of their own. The whistleblowers stand to receive up to 15-30% of the settlement in accordance with 31 U.S.C. § 3730(d)(1) and (2).
Contact Us
If you have information of healthcare fraud against the federal government or the State of California occurring here in San Francisco or elsewhere in the State, contact Ingrid M. Evans at Evans Law Firm at (415) 441-8669, or toll-free at (888)-50EVANS (503-8267) or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>. In addition to False Claims cases, Ingrid also represents individual whistleblowers in qui tam cases involving bank fraud under FIRREA/FIAFEA, commodity trading and securities fraud under the Commodities Futures Trading Commission Whistleblower Program and the Securities and Exchange Commission Whistleblower Program, and tax fraud under the Internal Revenue Service Whistleblower Program
[1] Evans Law Firm, Inc. was not involved in the case in any way.
