ATTORNEY NEWSLETTER
Alleged Inflated Reimbursements From Medicare And Medicaid
Former Employee Brings Qui Tam Action
How Whistleblower Cases Work
Private citizens and businesses help the government recover billions every year in cases of fraud against the government. The private citizens and businesses assisted the government in recovering these funds by bringing civil lawsuits on behalf of the government under the False Claims Act, (“FCA”), 31 U.S.C. § 3729 et seq. The private individuals or businesses bringing the actions are known as “relators,” and the cases themselves referred to as “qui tam” cases. If the government recovers, the relators are eligible for rewards. 31 U.S.C. § 3730(d). Relators of fraudulent conduct are often employees, accountants, controllers or managers, or former employees or managers, or competitors of the business engaging in the fraud. If you have credible information of fraud against the government in violation of the FCA 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).
Recent Settlement[1]
The U.S. Department of Justice (DOJ) recently announced that a medical device manufacturer and its corporate parent have agreed to pay $700,000 to resolve allegations that they violated the False Claims Act by knowingly causing physicians to use incorrect codes to obtain inflated reimbursement from Medicare and State Medicaid programs for the use of their medical device
According to the government, the device was sold to physicians for use in a surgical procedure that involves cauterizing certain blood vessels. The United States alleged that, between 2014 and 2017, physicians performing procedures using the device were required to bill for the procedure using a temporary code, also known as a “T-Code,” assigned for new and emerging services. Because a procedure that is assigned such a code is considered experimental, reimbursement for the use of the device was often denied. To avoid such denials and increase potential reimbursement, defendants allegedly encouraged colorectal and general surgeons improperly to bill Medicare and Medicaid programs using other codes other than the T-code.
The federal share of the civil settlement is $598,121.23, and the state Medicaid share of the civil settlement is $101,877.77. State Medicaid programs are jointly funded by the federal and state governments.
“The integrity of federal healthcare programs depends upon compliance with coding and billing rules that are used to make coverage and reimbursement decisions,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We will hold accountable health care providers that knowingly submit false claims to federal health care programs that do not accurately reflect and bill for the work they perform.” The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by a former employee of defendant. The relator’s share from the proceeds of the settlement will be $115,500.
Starting A Qui Tam Action
Any False Claims Act whistleblower case begins by a relator filing a complaint under seal in the federal court usually for the United States District Court for the district where defendant is located or does business. At the same time, the relator submits a disclosure to the DOJ outlining the material evidence the relator has of the alleged false claims. 31 U.S.C. § 3730(b). The seal period of the complaint lasts 60 days during which the DOJ investigates the claims. 31 U.S.C. § 3730(b)(2). (If necessary, the government can, and often does, extend the 60-day period during which the allegations are kept under seal.) If the government decides to intervene in the case, the government essentially takes over the litigation. 31 U.S.C. § 3730(c)(1). If the government declines to intervene, the relator may proceed with the litigation on his or her own. 31 U.S.C. § 3730(c)(3).
Contact Us
If you have credible information of government fraud in San Francisco or elsewhere in California, 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.
