30 March 2023. In recent years, we have seen a sharp increase in the number of whistleblower cases that involve healthcare fraud. In 2022, the U.S. Department of Justice reported $1.7 billion in False Claims Act settlements and judgments relating to healthcare fraud cases. This year, one recent healthcare fraud case involved a neurosurgeon and his fiancée who were accused of engaging in an illegal kickback scheme. The whistleblowers in this case were able to prevail in a False Claims Act qui tam lawsuit.
The allegations in this case centered around the neurosurgeon and his fiancée’s involvement in a scheme to receive kickbacks from spinal implant companies. Several whistleblowers, who were largely medical providers themselves, filed a qui tam lawsuit against the couple, alleging that they received remuneration from these companies in return for arranging for the use of their products in the neurosurgeon’s surgeries. This violated the Anti-Kickback Statute which regulates the behavior of healthcare providers and entities that receive payments from federal healthcare programs.
The neurosurgeon and his fiancée, as well as their medical device distribution company, Midwest Neurosurgeons, and DS Medical, were accused of participating in the scheme. The whistleblowers who brought the case to light alleged that they were aware of the illegal activities taking place and reported the wrongdoing to the authorities.
The case was filed as a False Claims Act qui tam lawsuit, which allows private individuals to sue on behalf of the government and receive a portion of any recovered damages. The whistleblowers will receive part of the $825,000 settlement.
The success of this case is reflective of the increasing importance of whistleblowers in identifying and reporting fraudulent activities in the healthcare industry. Without whistleblowers coming forward, these crimes may go unnoticed for years and cost taxpayers billions of dollars. Furthermore, it sends a strong message to those who may be considering engaging in similar illegal activities that they will be caught and held accountable for their actions.
Overall, the success of the whistleblowers in the False Claims Act qui tam lawsuit against this healthcare provider and co-conspirator demonstrates the importance of having strong whistleblower incentives and protection laws in place. The government depends on the reporting of fraudulent activities from those with inside knowledge, and the incentives provided through qui tam lawsuits can help to encourage whistleblowers to come forward.
If you would like to report Medicare fraud or any kickback scheme, you can contact attorneys at Tycko & Zavareei LLP. Eva Gunasekera and Renée Brooker are former officials of the United States Department of Justice and prosecuted whistleblower cases under the False Claims Act. Eva was the Senior Counsel for Health Care Fraud. Renée served as Assistant Director at the United States Department of Justice, the office that supervises False Claims Act cases in all 94 United States District Courts. Eva and Renée now represent whistleblowers. For a free consultation, you can contact Eva Gunasekera at [email protected] or contact Renée at [email protected] (tel.: 202-417-3664). Visit Tycko & Zavareei LLP’s website for whistleblowers to learn more at https://www.fraudfighters.net/.