ATTORNEY NEWSLETTER
Three Former Patients Blows Whistle On False Billing
Allegations Of Billing For Unnecessary Procedures
Realtors Will Share $147,250 Reward
Private citizens recover more money lost by the government to fraud every year than the government itself recovers through its own enforcement efforts. Most of the private cases are brought under the False Claims Act, 31 U.S.C. §§ 3729 et seq. (FCA). which allows individuals with knowledge of fraud against the federal government to bring actions on behalf of the government (known as “qui tam” actions) to recover government funds paid out as a result of fraudulent claims. 31 U.S.C. §3730(b). If the government recovers, these individuals, known as “relators,” are eligible for rewards. 31 U.S.C. § 3730(d). Relators of fraudulent conduct are often employees of the business engaging in the fraud. Any business billing the government for products or services is subject to government regulation affecting that business and its billing practices for government work, and is also subject to the fines and penalties of the FCA. If you have credible information of government fraud in San Francisco or elsewhere in California, call us today at (415)441-8669 and we can help. Our toll-free number is 1-888-50EVANS (888-503-8267).
Doctor Settles FCA Allegations For $775,000
In a recent settlement announced by the U.S. Department of Justice,[1] a physician has agreed to pay $775,000 to resolve claims he violated the False Claims Act by submitting or causing the submission of false claims for payment to federal health care programs related to alleged medically unnecessary surgical procedures that he performed. According to the government, for a period of six years the doctor knowingly submitted false claims for payment to federal health care programs related to (1) radical hysterectomies and modified radical hysterectomies that the doctor performed when only simple hysterectomies were medically necessary; (2) chemotherapy services that were in excess of what was medically necessary; and (3) evaluation and management services that were not performed or not rendered as represented. Last year, a hospital involved in the case agreed to pay $2.8 million to resolve claims that it violated the False Claims Act by submitting or causing the submission of false claims for payment to federal health care programs related to alleged medically unnecessary procedures performed by the doctor.“Every day, patients rely on their doctors’ medical judgment to determine what type of medical care is reasonable and necessary,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We will continue to pursue doctors who knowingly abuse this trust and subject their patients to unnecessary treatments or procedures.”
Fundamentals Of A Qui Tam Case
The reported case was brought by three former patients of the physician, and they will share in a $147,250 reward. Qui tam cases begin with filing a complaint in the federal district court where the allegedly fraudulent conduct occurred. 31 U.S.C. § 3730(b). The complaint is filed under seal. The government has sixty days to review the allegations and decide whether to intervene. This review period can be extended. If the government decides to intervene, the government essentially takes over the litigation. 31 U.S.C. § 3730(c). If the government decides not to intervene, the relator has the right to continue the litigation on his or her own. If the relator continues the litigation alone, he or she receive a larger percentage of the amount the government eventually recovers. 31 U.S.C. § 3730(d). The relator may also pursue claims for wrongful retaliation against the defendant if the relator was fired or demoted as a result of blowing the whistle. 31 U.S.C. § 3730(h).
Contact Us
If you have credible information of government fraud call Ingrid M. Evans at (415) 441-8669, or toll-free at 1-888-50EVANS (888-503-8267) or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>. In addition to FCA and CFCA whistleblower cases, Ingrid and Evans Law Firm, Inc. also handle bank fraud whistleblower cases 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. The qui tam case is captioned U.S. ex rel. Satchwell v. Ascension Health, No. 17-CV-12315 (E.D. Mich.)
