April 22, 2021 — The United States Department of Justice settled a case against Massachusetts Eye and Ear Infirmary, Massachusetts Eye and Ear Associates, Inc., and the Foundation of the Massachusetts Eye and Ear Infirmary, Inc. (collectively “Massachusetts Eye and Ear”), healthcare providers and their management company. Under the terms of the settlement, Massachusetts Eye and Ear paid $2.675 Million.
Massachusetts Eye and Ear provides inpatient and outpatient services to people with a range of diseases involving the eye, ear, nose, and throat. Over an eight-year period, Massachusetts Eye and Ear improperly billed Medicare and MassHealth (Massachusetts’ Medicaid program) for certain office visits and procedures, allegedly defrauding the United States of more than a million dollars.
The United States contends that between January 1, 2012, and February 1, 2020, Massachusetts Eye and Ear regularly received reimbursements from Medicare and MassHealth for claims for office visits and procedures involving nasal endoscopies and laryngoscopies that were not performed. Massachusetts Eye and Ear mischaracterized their billing for such procedures since the actual type of office visits and procedures that were performed are not allowed under Medicare and MassHealth. Thus, as a result of the illegal conduct, Massachusetts Eye and Ear obtained reimbursements to which it was not entitled.
“When health care providers submit improper claims to Medicare and Medicaid, they do two bad things: they unjustly enrich themselves, and they drain money needed for legitimate patient care,” said Acting United States Attorney Nathaniel R. Mendell. “This settlement punishes bad billing and helps safeguard government health care programs from fraud, waste and abuse.”
“Our federal healthcare system relies on the basic premise that providers abide by the rules and bill properly, and the American taxpayers who fund the Medicare and Medicaid programs deserve nothing less,” said Phillip Coyne, Special Agent in Charge, Office of the Inspector General of the U.S. Department of Health and Human Services.
This settlement resolves a lawsuit brought by a whistleblower under the qui tam provisions of the False Claims Act, which allow private parties, known as “relators,” to bring suit on behalf of the government and to share in any recovery. Whistleblowers are protected against retaliation under the whistleblower provisions of the False Claims Act. For demonstrating a commitment to protect the integrity of Medicare and Medicaid, the whistleblower, in this case, will receive 15% of the recovery which is $401,250.
The Department of Justice needs whistleblowers to report healthcare fraud to help protect healthcare programs and patients, and to hold accountable any company that commits fraud, waste, or abuse in the Medicare, Medicaid, and other government programs.
The authors are attorneys at Tycko & Zavareei LLP. They are former officials of the United States Department of Justice and prosecuted claims under the False Claims Act. Eva Gunasekera was a Senior Counsel for Health Care Fraud and Renée Brooker was an Assistant Director for all Civil Frauds. Eva and Renee now represent whistleblowers. If you would like to report fraud, waste, or abuse, contact Renée at email@example.com or 202-417-3664. Or contact Eva Gunasekera at firstname.lastname@example.org. See, also, Tycko & Zavareei LLP’s special website https://www.fraudfighters.net/.