ATTORNEY NEWSLETTER
Formerly Employed Physician Blows Whistle
Allegations Of Kickbacks And Unnecessary Testing
Starting A False Claims Qui Tam Case
Healthcare providers in the U.S., including 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 and San Francisco whistleblower attorneys at Evans Law Firm, Inc. represent 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] an oncology practice and its affiliated physicians and a medical laboratory will pay a combined $ 4 million, plus interest, to resolve False Claims Act and Anti-Kickback Statute violations. The lawsuit was brought by a formerly employed physician at one of the defendant practices, who will receive a reward for his efforts. According to the allegations, the oncology practice conspired with a diagnostic reference laboratory, to create a kickback scheme. The practice would allegedly receive $115 per biopsy they referred to the lab, who performed in-office bone marrow biopsies and diagnostic testing. These payments were received by the private practices of three physicians employed by the practice, according to the complaint. One of the practice’s physicians also allegedly performed medically unnecessary services subsequently billing Medicare, TRICARE, and Texas Medicaid for those treatments.
Paying for biopsy referrals constitutes a kickback under the Anti-Kickback Statute, which makes it illegal for healthcare providers to offer incentives in return for referrals. Kickbacks harm patients by subjecting them to providers who put profits over people, possibly leading to poor quality or even harmful services.
The Special Agent in Charge with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) stated, “Violations of the Anti-Kickback Statute involving oncology services can waste scarce federal health care program funds and corrupt the medical decision-making process … Individuals who participate in the federal health care system are required to obey laws meant to preserve both the integrity of program funds and the provision of appropriate, quality services to patients.”
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.
