Allegations of Six-Year Fraud Against Medicare And Other Government Programs
Whistleblower Alleged Illegal Inducements And Unnecessary Inpatient Admissions
Former Patient Advocate Blew The Whistle
The federal Anti-Kickback Statute, 42 U.S.C. § 1320a-7b, prohibits offering, soliciting, or receiving any remuneration to induce referrals for medical services or procedures, including inpatient services., where the services are paid for by government programs. This proscribed conduct also constitutes a violation of the False Claims Act. See federal False Claims Act (FCA), 31 U.S.C. §§ 3729 et seq. Illegal kickbacks are only one form of healthcare fraud actionable under the FCA and CFCA; other types of fraud include overbilling, selling unapproved drugs or medical devices, false certifications and eligibility records or billing for services that were never provided. Individuals with knowledge of illegal kickbacks can be rewarded for bringing suit against the offending companies who defraud these programs. The suit is initiated by filing complaints known as “qui tam” complaints, and the whistleblower/plaintiff bringing the suit on behalf of the government is referred to as the “relator.” 31 U.S.C. § 3730(b)(federal). If you have credible information of illegal kickbacks or other healthcare fraud here in Los Angeles County or elsewhere in California, call us today at (415)441-8669 and we can help.
Allegations of Illegal Kickbacks
In a recent settlement announced by the U.S. Department of Justice, a group of psychiatric hospitals will pay $10.25 million to resolve alleged violations of the False Claims Act for improperly providing free long-distance transportation to patients and admitting patients at who did not require inpatient psychiatric treatment, resulting in the submission of false claims to the Medicare program. This settlement resolves allegations that, between August 2013 and June 2019, defendants provided free long-distance van transportation to patients to induce them to seek treatment at the defendants’ facilities, in violation of the Anti-Kickback Statute, and then submitted claims for services provided to these patients, in violation of the False Claims Act. The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by a federal health care program, such as Medicare, Medicaid or TRICARE. The government also alleged that defendants submitted, or caused to be submitted, false claims to Medicare for medically unnecessary inpatient psychiatric admissions and associated services at the two hospitals. “Kickbacks to patients can result in unnecessary services that serve neither the patients nor our federal health care programs,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “The Justice Department is committed to pursuing unlawful remunerations in whatever form they occur to safeguard taxpayer funded health care benefits.”
“Submitting false claims by billing for unnecessary inpatient psychiatric hospitalizations is not only inappropriate – it’s illegal,” said Acting U.S. Attorney Vipal J. Patel for the Southern District of Ohio.
“Kickbacks in the form of free van rides and the false claims subsequently submitted to federal health care programs come at a tremendous cost to patients and the taxpayers,” said Special Agent in Charge Lamont Pugh for the Office of Inspector General of the U.S. Department of Health and Human Services (HHS-OIG). “We will continue to work with our law enforcement partners to pursue and hold accountable entities who engage in such acts.”
Former Patient Advocate Will Receive Reward
A former advocate for patients of one of the hospitals will receive a reward for first bringing this case on behalf of the government. Although this relator was a former employee of one of the defendants, currently employed individuals may also have knowledge of fraud against government programs and are protected from employer retaliation for bringing false claims qui tam cases. 31 U.S.C. § 3730(h). If you are fired because you brought any fraud to light, you can fight back. You may be entitled to sue your employer in court (usually where your underlying qui tam case is filed) 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). Our whistleblower attorneys 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 and our other Los Angeles County whistleblower attorneys at (415) 441-8669, or by email at <a href=”mailto:firstname.lastname@example.org”>email@example.com</a>. In addition to FCA and CFCA whistleblower cases, we also handle 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 cases in any way. The qui tam case is captioned United States ex rel. Baker v. Oglethorpe, Inc., et al., No. 2:16-cv-1040 (S.D. Ohio).