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Nov 30, 2020 by |

California False Claims Act Whistleblower Attorney: Physician Group Settles Overbilling Allegations

ATTORNEY NEWSLETTER

Medicare Fraud Allegations In Whistleblower Case

Nurse Practitioner Time Allegedly Charged At Physician Rate

Physician Group Settles For $341,690

The federal government loses tens of billions every year in fraudulent Medicare billing.  Part of that loss comes from overbilling by health care providers, including hospitals, drug and medical device manufacturers, laboratories and clinics, nursing homes, and physician groups.  Individuals with information of healthcare fraud can help the government recover by initiating whistleblower (also known as qui tam) suits under the False Claims Act (FCA), 31 U.S.C. §§ 3729 et seq., which entitle the whistleblowers to rewards if the government recovers.  31 U.S.C. § 3730(d).   The whistleblower attorneys at Evans Law Firm, Inc. represents individuals who bring FCA cases based on any manner of fraud against the government including overbilling Medicare or Medicaid.  If you have credible, original information of healthcare fraud, call us today at (415)441-8669 or toll free at 1-888-503-8267 and we can help.

Overbilling At Higher Reimbursement Rates

Medicare pays a higher rate for physician services than for non-physician services.  In a recently announced settlement,[1] the Department of Justice (DOJ) alleged that, from 2015 to 2018, a physicians group billed Medicare as though the physicians had provided certain services to Medicare patients, when in fact nurse practitioners had treated the patients without the supervision of a physician.  Indeed, the government alleged that the services were rendered when the physicians were out of the office, including times when they were traveling out of state or abroad.  “Falsely billing Medicare for services by absent physicians encourages fraud, waste, and abuse of taxpayer funds and can ultimately harm patients,” said D. Michael Dunavant, U.S. Attorney for the Western District of Tennessee. “Settlements like this achieve provider accountability, protect public funds, and safeguard the beneficiaries of federal health care programs.”   

Bringing A Qui Tam Suit

A whistleblower or qui tam suit begins with the credible, original information of a fraud, usually discovered by an employee, former employee, or other insider.  Whistleblower attorneys, like the attorneys at Evans Law Firm, initiate your case by drafting and filing a complaint which is filed under seal in federal court.  31 U.S.C. § 3730(b).  A copy of the complaint is also served on the DOJ along with a disclosure statement presenting the material evidence that supports the allegations of the FCA violations.  31 U.S.C. § 3730(b).  The complaint is kept under seal until the government reviews the complaint and decides whether to intervene in the case.  Id.  If the government recovers, the whistleblower is entitled to a share of the recovery as a reward.  31 U.S.C. § 3730(d).  Employers are not permitted to retaliate against any employee who brings an FCA case, and if the employer violates the anti-retaliation rules, the whistleblower can sue the employer for reinstatement, double back pay, interest, and attorneys fees and expenses.  31 U.S.C. § 3730(h).  Evans Law Firm can represent you in any wrongful retaliation suit in addition to representing you in your underlying whistleblower case.

Contact Us

If you have information regarding Medicare overbilling, contact Ingrid M. Evans and the other California whistleblower attorneys at Evans Law Firm at (415) 441-8669, or toll free at 1-888-503-8267, or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>.   Ingrid and our other whistleblower attorneys also handle cases involving bank fraud 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

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

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