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Feb 2, 2021 by |

San Diego County Whistleblower Attorney: Hospital Settles Claims Of Alleged Kickbacks

ATTORNEY NEWSLETTER

$48 Million Settlement Of False Claims Case

Former Physicians/Owners Blow Whistle

Allegations of Illegal Kickbacks And Contractual Obligations

Current and former employees and even former owners of businesses may have information of health care fraud against the government by clinics, labs, hospitals, nursing homes, home health agencies, drug makers, equipment suppliers, physician groups, and others.  Those individuals can be rewarded under the False Claims Act (FCA), 31 U.S.C. § 3729 et seq., for bringing a case on behalf of the government (known as a “qui tam”) when the government recovers from the wrongdoers. 31 U.S.C. § 3730(d).  Evans Law Firm, Inc. represents whistleblowers with credible information of illegal referral kickbacks, overbilling, false certifications, reimbursement for unapproved medications, miscoding procedures, or other fraud perpetrated in the context of government payment for medical services, drugs, and devices.  Often, the fraudulent conduct involves violations of more than one federal or State statute, and our whistleblower attorneys draft your allegations to cover all possible violations and seek all applicable remedies under the law.   If you have credible information of fraud against the government call the San Mateo whistleblower attorneys at Evans Law Firm, Inc. today at (415) 441-8669.

Improper Financial Inducements

In one recent settlement of a large FCA case[1] a partially physician-owned hospital and a wholly owned subsidiary have agreed to pay the United States $48 million to resolve claims that the hospital violated the False Claims Act by knowingly submitting claims to the Medicare program that resulted from violations of the Anti-Kickback Statute (42 U.S.C. § 1320a-7b) and the Stark Law (42 U.S.C. § 1395nn (“Limitation on certain physician referrals”)). The Anti‑Kickback Statute prohibits offering or paying remuneration to induce the referral of items or services covered by Medicare, Medicaid, and other federally funded programs. The Stark Law prohibits a hospital from billing Medicare for certain services referred by physicians with whom the hospital has a financial relationship, unless that relationship satisfies one of the law’s statutory or regulatory exceptions.  Both the Stark Law and the Anti-Kickback Statute are intended to ensure that medical judgments are not compromised by improper financial inducements. The complaint alleged that the hospital violated these statutes by requiring physician owners to satisfy the hospital’s yearly 48 patient-contact requirement in order to maintain the physicians’ partial ownership interest in the hospital.  Two of the former physician owners blew the whistle on these statutory violations and will share a $13,920,000 reward according to the government announcement. 

Bringing Fraud To Government Attention Through Qui Tam Cases

The government’s intervention in this reported case illustrates how individual whistleblowers can induce the government to intervene and prosecute cases under the FCA against businesses and individuals who defraud the government.  Cases begin with a sealed complaint alleging the violations supported by the whistleblower’s original and credible information of a defendant’s fraud against the government.  The complaint is filed under seal in the federal court.  31 U.S.C. § 3730(b).  The seal period lasts 60 days during which the government investigates your claims.  31 U.S.C. § 3731(b)(2).  If necessary, the government can, and often does, extend the 60-day period during which the allegations are kept under seal.  In complex cases, the government investigation may last for considerable periods of time and include review of years of information and documentation and interviews of all persons involved.  From the filing of the complaint and throughout the process, employers are prohibited from retaliating against you for bringing a FCA qui tam case, and your complaint can include claims for relief against your employer’s retaliatory actions.  31 U.S.C. § 3730(h).

Contact Us

Ingrid M. Evans and the other San Diego County and California Evans Law Firm whistleblower and qui tam attorneys represent individuals with any kind of health care fraud information.  Typically, such persons are insiders such as former owners, employees, former employees, auditors, bookkeepers, independent contractors, sales representatives, agents and the like.  If you have information of fraud call Ingrid and our other attorneys today at (415) 441-8669, or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>.  We 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.  The case is captioned United States ex rel. Mitchell J. Magee and Todd M. Dewey v. Texas Heart Hospital of the Southwest, L.L.P., et al., Case No. 4:16-CV-00717-ALM (E.D. Tex.).  The claims resolved by this settlement are allegations only and there has been no determination of liability.

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