Allegedly Shared Payments With Referring Providers
Total Of $36 Million Recovered In Alleged Scheme
How Qui Tam Cases Work
Healthcare providers in the U.S., including hospitals and clinics, are subject to a number of statutes to prevent any fraudulent billing under government programs like Medicare and Medicaid. When the providers violate those laws, they also violate the False Claims Act (“FCA”), 31 U.S.C. §§ 3729-3733, for submitting false claims for payment to the government. One of the underlying protections against fraud in the healthcare field is the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b, which prohibits kickbacks to physicians for patient referrals for services covered by Medicare and Medicaid (known as Medi-Cal in California). Individuals with information about this kind of scheme can be rewarded for bringing this kind of illegal practice to light. 31 U.S.C. § 3730(b). The California whistleblower attorneys at Evans Law Firm, Inc. represents individuals who bring FCA cases based for any kind of fraud against Medicare or Medicaid. If you have credible, original information of healthcare fraud, call us today at (415)441-8669 or toll-free at (888)-50EVANS (503-8267) and we can help.
Anti-Kickback Case Settlement
According to a recent U.S. Department of Justice (DOJ) press release, a clinical laboratory has agreed to pay $1,195,845 to resolve False Claims Act allegations that its marketers paid illegal kickbacks to healthcare providers in violation of the Anti-Kickback Statute to induce laboratory testing referrals.
“The payment of kickbacks by laboratories or their representatives to induce laboratory test referrals undermines the integrity of federal healthcare programs,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We will pursue those who offer or receive kickbacks for patient referrals regardless of how those unlawful inducements are characterized or provided.”
The Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded healthcare programs. The Anti-Kickback Statute is intended to ensure that medical providers’ judgments are not compromised by improper financial incentives and are instead based on the best interests of their patients.
The settlement resolves allegations that from 2019 to 2021 the lab paid healthcare providers a portion of the payments it received for the government in exchange for referrals. The health care providers allegedly were paid using purported management services organizations (MSOs), which attempted to disguise the kickbacks as investment returns but actually offered the payments to health care providers to induce referrals. Repvious actions based on the same allegations against other entities have resulted in a total of $36 million recovered by the government, according to the DOJ.
How False Claims Act Whistleblower Cases Work
Cases such as the case discussed above are often initiated under the qui tam, or whistleblower, provisions of the FCA. 31 U.S.C. § 3730(b). The FCA allow private parties to sue on behalf of the government for false claims, and to receive a share of any recovery. 31 U.S.C. § 3730(b) (procedures for initiating qui tam actions). The suit is filed confidentially and remains under seal giving the government time to review the allegations in the case. If the government decides to intervene, the government essentially takes over the case. If the government declines to intervene, the plaintiff has the right to continue the suit of their own. The whistleblowers stand to receive up to 15-30% of the settlement in accordance with 31 U.S.C. § 3730(d)(1) and (2).
If you have information of healthcare fraud against the federal government or the State of California occurring here in San Francisco or elsewhere in the State, contact Ingrid M. Evans at Evans Law Firm at (415) 441-8669, or toll-free at (888)-50EVANS (503-8267) or by email at <a href=”mailto:email@example.com”>firstname.lastname@example.org</a>. In addition to False Claims cases, Ingrid also represents individual whistleblowers in qui tam 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
 Evans Law Firm, Inc. was not involved in the case in any way.