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Feb 8, 2021 by |

Alameda County and California Whistleblower Attorney: Unsupervised Services and Unaccredited Facilities May Constitute Fraud Against The Government

ATTORNEY NEWSLETTER

Radiology Practice Settles Allegations in False Claims Qui Tam Case

Former Employee/Whistleblower Will Receive Share Of $5 Million Payment 

Department of Justice Targets Health Care Fraud

The government (and taxpayers) lose billions of dollars every year to fraud in the health care industry, primarily through fraudulent claims to Medicare and Medicaid and other government-sponsored health care programs like those provided by the Veterans Administration. Often persons employed in health care providers are the individuals with information regarding potential fraud.  Such 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.  Individuals with credible information begin a case (known as a “qui tam”) with a sealed complaint filed in federal court and may be eligible for a reward if the government recovers.  31 U.S.C. § 3729 et seq.(federal False Claims Act).   If you have credible information of fraud against Medicare, Medi-Cal or other government programs, call the Alameda County and California whistleblower attorneys at Evans Law Firm, Inc. today at (415) 441-8669.

Allegations of Unsupervised Services and Unaccredited Facilities

In a recently reported settlement of an FCA case,[1] the U.S. Department of Justice (DOJ) announced a $5 million settlement with a radiology practice to resolve allegations that they violated the False Claims Act (FCA) by knowingly submitting claims to Medicare and the military healthcare program, TRICARE, for unsupervised radiology services and services provided at unaccredited facilities.  Specifically, the settlement resolves allegations that the defendants submitted claims for CT scans and MRIs involving contrast injections that were not properly supervised by a physician.  Applicable program rules require a physician to be present in the office suite when a patient undergoes an examination that involves the administration of intravenous contrast material.  The defendants allegedly performed and billed for these procedures when no supervising physician was present in the office suite.  The settlement also resolves allegations that a certain number of the defendants’ facilities lacked accreditation.

Whistleblower Rewarded $925,000

The settlement in the reported case, which according to the DOJ was based on the defendants’ ability to pay, resolves allegations originally brought in a lawsuit filed under the qui tam, or whistleblower, provisions of the FCA by an individual, who was formerly employed by the defendants.  The FCA permits private parties to sue on behalf of the government for false claims and to receive a share of any recovery.  31 U.S.C. § 3730(d). The whistleblower here will receive approximately $925,000 of the settlement proceeds.  In the reported case, the whistleblower was a former employee.  But the FCA protects current employees from employer retaliation for bringing a case.  31 U.S.C. § 3730(h).  Relief from retaliatory acts include reinstatement, double back pay with interest, other damages, and awards of attorneys’ fees and expenses for bringing your case.  The whistleblower attorneys at Evans Law Firm can represent you in any claims for wrongful termination/retaliation in addition to representing you in your underlying qui tam case.

Contact Us

Ingrid M. Evans and the other Alameda County Evans Law Firm whistleblower and qui tam attorneys at (415) 441-8669, or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a> represent individuals like the former employee in the above case, who have information of an employer’s fraudulent practices that may be appropriate for a qui tam case under the False Claims Act.  Ingrid and the other Alameda County 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. 

[1] Evans Law Firm, Inc. was not involved in the case in any way.

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