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Jan 5, 2021 by |

California and San Francisco Whistleblower Attorney: Addiction Center Faces Allegations of Healthcare Fraud

ATTORNEY NEWSLETTER

Addiction Center Allegedly Charged Government Millions For Unnecessary Tests

Provider Also Allegedly Unable To Ensure Quality Care

Physician And Former Medical Director Blew Whistle

Fraud against Medicare and Medicaid constitute violations of the False Claims Act (FCA), 31 U.S.C. §§ 3729 et seq., and also often other statutes such as the Stark Law, 42 U.S.C. § 1395nn (limitations on certain physician referrals) and the Anti-Kickback Statute, 42 U.S.C. §§ 1320a-7b(b)(prohibiting illegal kickbacks for referrals, products and services). The individual whistleblower cases are known as “qui tam” cases and are initiated under the FCA.  Whistleblowers may be eligible to receive up to 30% of any amounts the government recovers.  31 U.S.C. § 3730(d).  If you have credible information of fraud against the government, call the whistleblower attorneys at Evans Law Firm, Inc. today at (415)441-8669 or toll free at (888)50EVANS 503-8267 and we can help.

Addiction Center Allegedly Conducted Unnecessary Tests and Committed Other Violations

An ongoing case against an addiction center illustrates how unnecessary tests, illegal referrals or other violations of federal Medicare and Medicaid regulations constitute violations of the False Claims Act.  The allegations in that FCA case[1] were that the center prescribed millions of dollars of medically unnecessary urine tests and performed the tests at facilities also owned by the owner of the addiction center. This would violate state and federal laws prohibiting self-referral of lab testing. The complaint alleged that the owner had the center adopt policies that encouraged the referral of unneeded urine tests to be performed at laboratories that she owned or managed. The complaint also alleged numerous instances in which a patient needed a higher level of care than the center could provide, but those concerns were ignored and the center simply scheduled the patient for the next visit and the next buprenorphine prescription, followed by the next medically unnecessary confirmatory lab test.” These “unnecessary confirmatory” tests were then billed to Medicaid, resulting in alleged violations of the FCA and other statutes and regulations. The center denies all of the allegations in the complaint, and the case is still ongoing.

Starting and FCA Case

An FCA case always begins with credible information of the false claims usually possessed by an insider such as an employee or, as in the reported case above, a former employee or director. An experienced whistleblower attorney, such as the attorneys at Evans Law Firm, will then work that information into a complaint which is filed under seal in federal court.  31 U.S.C. § 3730(b).  The plaintiff (also known as the “relator”) serves the Attorney General’s office with a copy of the sealed complaint and a disclosure statement that provides the government with the material evidence backing up the allegations.  During the time that the complaint is under seal (starts with 60 days but can be renewed) the government decides whether it wishes to intervene in the case.  If the government chooses not to intervene, the relator may continue the litigation on her own.  The FCA prohibits employer retaliation against any employee that blows the whistle on fraud and the Evans Law Firm litigators can represent you in any suit for wrongful termination as well as representing you in the underlying qui tam action.

Contact Us

If you are an employee or other insider with original information of billing for unnecessary services, illegal referrals, kickbacks or other fraud against Medicare or Medicare Advantage, contact Ingrid M. Evans and the other California whistleblower and false claims attorneys at Evans Law Firm at (415) 441-8669, or toll free at (888)50EVANS 503-8267 or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>. In addition to FCA cases, Ingrid and our other whistleblower attorneys handle cases involving bank fraud under FIRREA/FIAFEA, options, futures, and commodities trading fraud under the Commodities Futures Trading Commission Whistleblower Program, securities violations under the Securities and Exchange Commission Whistleblower Program, financial advisor fraud under the FINRA Whistleblower Office and offshore tax avoidance schemes and other tax fraud before the Internal Revenue Service Whistleblower Office. 

[1] Evans Law Firm, Inc. was not involved in the case in any way.  The case is captioned U.S. et al. ex rel. Wendy Welch v. CleanSlate Cen­ters, Inc., et al.; Civil Ac­tion No. 17-CV-30038-MGM (D. Mass.).

 

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