ATTORNEY NEWSLETTER
Allegedly Unlawful Payments To Referring Doctors
Former Billing Manager Blows Whistle
Whistleblower To Receive Share Of Settlement As Reward
Private citizens can bring civil lawsuits on behalf of the government for redress against fraud under the False Claims Act, (“FCA”), 31 U.S.C. § 3729 et seq. In Fiscal Year 2022, private citizens and businesses helped the government recover $1.9 billion in cases of fraud against the government. The private individuals or businesses, known as “relators,” brought the cases, referred to as “qui tam” cases,” under the FCA. I f the government recovers, these individuals are eligible for rewards. 31 U.S.C. § 3730(d). Relators received over $488 million in rewards during Fiscal Year 2022, and multiple large rewards have been made in 2023. Much government fraud, and the majority of the qui tam cases brought every year, relate to fraud in the healthcare field, under programs like Medicare and Medicaid (known as Medi-Cal in California). Relators of fraudulent conduct are often employees or managers, or former employees or managers, or (in healthcare cases) patients 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 False Claims Act Settlement[1]
In a recent press release by the U.S. Department of Justice (DOJ), a mobile PET Scan provider has agreed to pay $85,480,000 to resolve False Claims Act allegations that the provider paid referring cardiologists excessive fees to supervise PET scans in violation of the Anti-Kickback Statute (AKS), 42 U.S.C. § 1320a-7b, and the Physician Self-Referral Law (Stark Law), 42 U.S.C. § 1395nn.
“Healthcare providers that pursue patient referrals through illegal kickbacks and other unlawful financial arrangements will be held accountable,” said Principal Deputy Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We will continue to safeguard federal healthcare funds by rooting out financial relationships between healthcare providers and referring physicians that can corrupt medical decision making and increase the cost of care.”
The United States alleged that defendant knowingly caused false or fraudulent claims to federal health care programs arising from violations of the AKS and the Stark Law. Specifically, the government alleged that defendant allegedly paid kickbacks to referring cardiologists in the form of above-fair market value fees of $500 or more per hour, ostensibly for the cardiologists to supervise the PET scans for the patients they referred to the company. The United States alleged these fees substantially exceeded fair market value for the cardiologists’ services because defendant paid the referring cardiologists for each hour defendant spent scanning the cardiologists’ patients, including time the cardiologists were away from the mobile scanning units providing care for other patients or were not even on site.
How A Qui Tam Action Begins
A former manager in defendant’s billing unit (referred to as the “relator”) initiated the case just described. She will receive a reward for her efforts. Any False Claims Act whistleblower case begins by a relator filing a complaint under seal in the federal court usually for the District in which the 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.
