Settlement of False Claims Act Case Against Medical Equipment Provider
$40.5 Million Settlement of Allegations
Three Former Employee/Whistleblowers Rewarded
Employees and former employees are most often the individuals who may have come across fraud against the government by their employers, particularly in the health care industry where the majority of fraud against the government occurs. Cases alleging such fraud are known as “qui tam” cases and are brought under the False Claims Act (FCA), 31 U.S.C. § 3729 et seq. for federal fraud and the California statute, Cal. Gov’t Code § 12650 et seq., for fraud against the State of California. The whistleblower litigators at Evans Law Firm, Inc. represent whistleblowers in both federal and State qui tam cases; sometimes the complaints involve allegations against both federal and State false claims. Healthcare fraud may occur through overbilling, false certifications, reimbursement for unapproved medications or defective or substandard devices, improperly “upcoding” procedures to obtain a higher level of reimbursement, paying illegal kickbacks or charging the government for discontinued or unnecessary procedures or equipment. If you have credible information of fraud that may be the basis for a whistleblower or qui tam case, call the San Mateo County and California whistleblower attorneys at Evans Law Firm, Inc. today at (415) 441-8669.
Fraudulent Medical Equipment Case
In a recently reported settlement of an FCA case, the U.S. Department of Justice (DOJ) announced today a $40.5 million settlement of a lawsuit against a large medical equipment provider alleging, among other claims, that defendant submitted false claims to federal health programs seeking reimbursement for the rental of costly non-invasive ventilators (“NIVs”) to program beneficiaries who were not using the NIVs such that the devices were not medically necessary or that involved the improper waiver of patient co-insurance payments. Under the settlement, defendant agreed to pay a total sum of $40.5 million, with $37,632,789.89 being paid to the United States and the remaining amount to be paid to various states. As part of the settlement, defendant also made extensive factual admissions regarding its conduct.
Allegations of Billing Fraud
As alleged in the complaint, defendant had decided to prioritize the expansion of its NIV rental business because health care programs like Medicare paid as much as $1,400 per month to cover NIVs. That expansion, however, allegedly came at the cost of defendant’s compliance with the basic medical necessity requirement of federal health programs. Specifically, the complaint alleged that defendant routinely billed Medicare and other programs when it did not know whether NIVs were still being used by patients or remained medically necessary. Even when defendant had information indicating that patients were no longer using their NIVs, the complaint alleged it often continued to bill the federal health programs. The complaint also alleged that defendant improperly billed federal health programs for rentals of more expensive equipment than was medically necessary and improperly waived co-pays for a number of Medicare and TRICARE beneficiaries to induce them to rent the equipment. According to the complaint, as a result of these improper practices, defendant submitted thousands of false claims to federal health programs for NIV rentals and fraudulently received millions of dollars in reimbursements.
The three former employees who brought a qui tam case based on this information stand to receive a share of the $40.5 million settlement as a reward for their efforts. Ingrid M. Evans and the other Evans Law Firm whistleblower and qui tam attorneys at (415) 441-8669, or by email at <a href=”mailto:firstname.lastname@example.org”>email@example.com</a> represent such individuals with false claims information that may be appropriate for a case. Ingrid and the other whistleblower attorneys also handle bank fraud whistleblower cases under the Financial Institutions Reform, Recovery, and Enforcement Act (FIRREA), commodities and futures trading cases under the Commodities Futures Trading Commission Whistleblower Program, securities fraud cases under the Securities and Exchange Commission Whistleblower Program and FINRA Whistleblower Office and offshore tax evasion and other tax fraud cases under the Internal Revenue Service Whistleblower Office.
 Evans Law Firm, Inc. was not involved in the case in any way.