Individual Blows Whistle on Illegal Kickback Scheme
Kickbacks Allegedly Included Foreign Vacations, Lavish Meals And Entertainment
Individual To Receive Share Of Reward
Private whistleblower suits (known as qui tam cases) under the False Claims Act (FCA), 31 U.S.C. §§ 3729 et seq., are hands down the primary tool by which the federal government recovers money from individuals and businesses who defraud the government in their requests for payment or reimbursement. The health care industry is the leading source of such fraud, with billions in Medicare reimbursements paid out every year on fraudulent claims for payments. In fiscal year 2020 alone, the federal government recovered $2.2 billion in FCA settlements and judgments. Almost 82% of that amount, or $1.8 billion, involved the health care industry. Whistleblowers personally recover anywhere from 15% to 30% of the damages and penalties or settlement once the government recovers. 31 U.S.C. § 3730(d). If you have credible information of fraud against the government here in Orange County or elsewhere in California, call us today at (415)441-8669 and we can help. Our toll-free number is 1-888-50EVANS (888-503-8267).
Recovery From Foreign Medical Device Manufacturer
In one recently settled case announced by the U.S. Department of Justice (DOJ), an insider exposed the lavish entertainment of physicians by a French medical device manufacturer and its American company to allegedly induce those physicians to buy or order the device companies’ spinal devices to implant in patients. According to the FCA complaint filed in the case, this conduct violated the FCA and the Anti-Kickback Statute, 42 U.S.C. § 1320a-7(b), which prohibits doctors or other medical professionals from having their medical judgment influenced by some form of financial payment or remuneration. In this case, the device maker allegedly paid for the physicians to travel abroad, have lavish meals, alcoholic beverages, and entertainment. These types of “benefits” are seen as kickbacks to induce or encourage the doctors to use the spinal devices sold by foreign and American companies to Medicare, Medicaid, and TRICARE patients. According to the DOJ, such carrot and stick incentives can warp the physician-patient relationship and for that reason are illegal.
In the settlement, the government collected $1M under the False Claims Act and $1M under the Open Payments Program, administered by the Centers for Medicare and Medicaid Services. The Whistleblower will receive a share of the Government’s recovery. The settlement is one of the first settlements under both the False Claims Act and the Open Payments Program. The Open Payments Program requires companies like device and drug manufacturers to report any payments to physicians. The purpose is to make the public knowledgeable about any such payments so that kickbacks to physicians are transparent and avoided. This newer enforcement tool was urged by Congress in 2019 to require action against companies that fail to comply with the Open Payments Program. Congress had expressed concern about physician-owned distributorships (PODs) whereby a physician owned a share in an entity that sells implantable medical devices used in the physician’s surgeries. In such an instance, the physician would have a financial incentive to purchase the device and implant them into patients. Congress saw that as a big “no-no” to protect patient safety.
Remedies for Employer Retaliation
Many FCA qui tams are brought by employees of the offending businesses because they are the persons with original information of the fraud being perpetrated against the government. The False Claims Act protects employees against retaliation from their employers for blowing the whistle on any fraud against the government. But despite this legal prohibition, companies continue to retaliate against whistleblowers and often invent pretexts for getting rid of whistleblowers to disguise their true intent in terminating the individual. Fortunately, the law allows employee whistleblowers to fight back. 31 U.S.C. § 3730(h). If you are fired because you brought any fraud to light, you may be entitled to sue your employer in court and seek double back pay (with interest), reinstatement, reasonable attorneys’ fees, and reimbursement for certain costs in connection with the litigation. 31 U.S.C. § 3730(h)(2). Evans Law Firm, Inc. can represent you in any action for retaliation as well as represent you in your underlying whistleblower application.
If you have credible information of government contractor fraud against Medicare or Medi-Cal call Ingrid M. Evans at (415) 441-8669, or toll-free at 1-888-50EVANS (888-503-8267) or by email at <a href=”mailto:firstname.lastname@example.org”>email@example.com</a>. In addition to FCA and CFCA whistleblower cases, Ingrid also handles bank fraud whistleblower cases under FIRREA/FIAFEA, commodity trading and securities fraud under the Commodities Futures Trading Commission Whistleblower Program and the Securities and Exchange Commission Whistleblower Program, and tax fraud under the Internal Revenue Service Whistleblower Program.
 Evans Law Firm, Inc. was not involved in the case in any way.