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May 24, 2021 by |

San Diego False Claims Whistleblower Attorney: Eye And Ear Infirmary Resolves False Claims Allegations For $2.6 Million


Allegations of Improper Billing

Patient Blew Whistle On Fraud

Whistleblower Will Receive Reward

Healthcare fraud is the largest form of fraud against the federal government.  Typically, the fraud is against Medicare or Medicaid, and patients or persons who work in the companies defrauding the government may discover the fraud.  When individuals have information of this kind of fraud, they can bring an action against the offending corporation under the False Claims Act, 31 U.S.C. §§ 3729 et seq. (FCA).  These cases (called qui tams) can result in a reward for the individual bringing the action (referred to as relators).  31 U.S.C. § 3730(c).  Various kinds of health care providers may commit this kind of fraud including infirmaries, pharmaceutical companies, medical device manufacturers and distributors, pharmacies, hospitals, nursing homes, physician groups, testing and diagnostic labs, therapy providers, home health care agencies and others. Relators in whistleblower cases put a lot of time and work in qui tam cases but the reward can be a substantial percentage of whatever the government ultimately recovers.  31 U.S.C. § 3730(d).  Evans Law Firm, Inc. represents whistleblowers in qui tam cases in San Diego and throughout California.  If you have credible information of fraud against the government that may be the basis for a whistleblower or qui tam case, call us today at (415) 441-8669.

Overbilling Case

On April 21, the U.S, Department of Justice (DOJ) announced a settlement of one healthcare fraud qui tam case,[1] against an eye and ear infirmary for overbilling.  The infirmary has agreed to pay $2.678 million to resolve allegations that the infirmary violated the False Claims Act.  The relator, a patient of the infirmary, will receive 15 percent of the recovery, or roughly $401,700 as a reward.  According to the DOJ’s announcement, the infirmary improperly billed federal health care programs over an eight-year period for certain office visits, defrauding the United States of more than a million dollars. Specifically, according to the DOJ, the infirmary regularly submitted claims to Medicare and Medicaid for office visits at which physicians performed certain medical procedures, specifically, nasal endoscopies and laryngoscopies. The infirmary billed Medicare and Medicaid separately for the visit and for the procedures.  Medicare and Medicaid regulations, however, do not permit billing for such office visits in addition to billing for the procedures, except under special circumstances that were not present according to the DOJ. As a result of the allegedly illegal conduct, the infirmary obtained reimbursements to which it was not entitled.

“When health care providers submit improper claims to Medicare and Medicaid, they do two bad things: they unjustly enrich themselves, and they drain money needed for legitimate patient care,” said Acting United States Attorney Nathaniel R. Mendell. “This settlement punishes bad billing and helps safeguard government health care programs from fraud, waste and abuse.”

How Qui Tam Cases Begin

In the reported case, it was a patient who uncovered the allegedly fraudulent billing practices of the infirmary.  Individuals with original and credible information of false claims, like the patient in this case, begin FCA qui tam cases by filing a complaint under seal in the federal court. At the same time, the relator submits a disclosure to the DOJ outlining the material evidence the relator has of the alleged false claims. 31 U.S.C. § 3730(b). The seal period of the complaint lasts 60 days during which the DOJ investigates the claims.  31 U.S.C. § 3730(b)(2). (If necessary, the government can, and often does, extend the 60-day period during which the allegations are kept under seal.)  If the government decides to intervene in the case, the government essentially takes over the litigation. 31 U.S.C. § 3730(c)(1).   If the government declines to intervene, the relator may proceed with the litigation on his or her own.  31 U.S.C. § 3730(c)(3).

If you are an employee with information of fraud, you employer is prohibited from retaliating against you for bringing a FCA qui tam case, and your complaint can include claims that the defendant unlawfully retaliated against you.  31 U.S.C. § 3730(h).  Whether your claims are included in the underlying qui tam or the subject of an independent action for damages, reinstatement, double back pay with interest and all other available relief, we can represent you in pursuing that relief.

Contact Us

If you have information regarding a whistleblower or qui tam case for any kind of healthcare fraud against the government here in San Diego, contact Ingrid M. Evans at (415) 441-8669, or by email at <a href=””></a>. In addition to False Claims Act cases, Ingrid also handles 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.

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