May 16, 2023. Whistleblowers who uncover fraud by their employers play a crucial role in enforcing the False Claims Act. The False Claims Act offers significant financial rewards and protections for those individuals willing to come forward. The Department of Justice settled three qui tam lawsuits filed against a Beverly Hills, California plastic surgeon and his son, medical practices, and billing company. These lawsuits were successful thanks to the bravery of three individuals who came forward to blow the whistle. The whistleblowers—a billing company, a podiatrist, and a billing department employee—are entitled to receive 15-25% of the government’s recovery, which was $24 million across these cases.
According to the allegations, over a period of six years, the healthcare provider and co-conspirators improperly billed both Medicare and Medicaid for skin graft surgeries. The healthcare provider allegedly falsely documented the place of service for skin grafts and billed multiple times for single-use skin substitute products, claiming surgeries took place in ambulatory surgery centers instead of in physician offices. Medicare and Medicaid reimburse more for surgeries in ambulatory surgery centers, so the healthcare provider received excess payments from these state- and federally-funded healthcare programs, in violation of the False Claims Act. Some of the products used in the skin graft surgeries are intended to be single use. Besides finding ways to double bill for these products based on the location in which the surgeries were performed, the fraudsters used the leftover skin substitute materials from one surgery in other surgeries, billing the government twice for the same material.
California has a state False Claims Act, meaning Californians can sue on behalf of the state government to recover funds from fraudsters. The healthcare provider and his son have been excluded from Medicare and Medicaid for a period of 15 and 3 years, respectively. The healthcare providers will pay $497,619 to California to settle these allegations of Medicaid fraud; about half of that amount is restitution.
The whistleblowers who filed these qui tam lawsuits were essential for the case’s success. These individuals risked their careers and reputations to come forward, and the successful outcome of the case is a testament to their courage and commitment to upholding the law. The False Claims Act provides a powerful tool for whistleblowers to come forward and report fraud, and the government is very serious about taking enforcement action against those who violate the law. It is important to note that whistleblowers should seek legal counsel before filing a qui tam lawsuit because a whistleblower is not allowed to proceed unrepresented. An experienced False Claims Act attorney can provide guidance on the process and increase the chances of a successful case and financial reward. The lawyer can also help the whistleblower navigate potential retaliation from the accused employer.
If you would like to report Medicare and Medicaid fraud, 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/.