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Nov 21, 2022 by |

San Francisco Whistleblower Attorney: Therapy Provider Agrees To Pay $7.175 Million To Resolve Allegations of False Billing

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In Fiscal Year 2021, private citizens helped the government recover $1.6 billion in cases of fraud against the government.  The citizens, known as “relators,” brough the cases, referred to as “qui tam” cases,” under the False Claims Act, 31 U.S.C. §§ 3729 et seq. (FCA).  The FCA allows individuals with knowledge of fraud against the federal government to initiate actions on behalf of the government to recover government funds paid out as a result of fraudulent claims.  31 U.S.C. §3730(b).  If the government recovers, these individuals are eligible for rewards. 31 U.S.C. § 3730(d).  Relators of fraudulent conduct are often employees, or former employees, of the business engaging in the fraud.  Each year relators in FCA cases recover billions of dollars for the government. Any business billing the government for products or services is subject to government regulation affecting that business and its billing practices for government work, and is also subject to the fines and penalties of the FCA.  Healthcare fraud is the largest type of fraud perpetrated against the government every year for false claims under federal programs like Medicare and Medicaid. If you have credible information of government fraud in San Francisco or elsewhere in California, call us today at (415)441-8669 and we can help. Our toll-free number is 1-888-50EVANS (888-503-8267).

Therapy Provider Settles FCA Allegations For $7.175 Million

In a recent settlement announced by the U.S. Department of Justice,[1] a home health provider and its affiliates and certain officers  have agreed to pay $7.175 million to resolve allegations that they violated the False Claims Act by billing the Medicare program for medically unnecessary therapy provided to patients.   Between 2014 and 2016, defendant allegedly billed the Medicare Program knowingly and improperly for home healthcare to patients based on therapy provided without regard to medical necessity and overbilled for therapy by upcoding patients’ diagnoses. 

“Payment under Medicare for home health care is permitted only for those who provide medically necessary services to eligible beneficiaries,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Department of Justice’s Civil Division. “As this settlement demonstrates, the Department is committed to ensuring that providers bill only for appropriate procedures and amounts.”

“Medicare fraud costs our taxpayers billions annually,” said U.S. Attorney Juan Antonio Gonzalez Attorney for the Southern District of Florida. “These overpayments drain the Medicare trust fund and unfairly raise the premiums our senior citizens must pay. We take this fraudulent activity very seriously and will continue to prosecute it to the fullest extent of the law.”

Fundamentals Of A Qui Tam Case

Qui tam cases begin with filing a complaint in the federal district court where the allegedly fraudulent conduct occurred.  31 U.S.C. § 3730(b).  The complaint is filed under seal.  The government has sixty days to review the allegations and decide whether to intervene.  This review period can be extended.  If the government decides to intervene, the government essentially takes over the litigation.  31 U.S.C. § 3730(c).  If the government decides not to intervene, the relator has the right to continue the litigation on his or her own.  If the relator continues the litigation alone, he or she receive a larger percentage of the amount the government eventually recovers.  31 U.S.C. § 3730(d).  The relator may also pursue claims for wrongful retaliation against the defendant if the relator was fired or demoted as a result of blowing the whistle.  31 U.S.C. § 3730(h).

Contact Us

If you have credible information of government fraud call Ingrid M. Evans at (415) 441-8669, or toll-free at 1-888-50EVANS (888-503-8267) or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>.  In addition to FCA and CFCA whistleblower cases, Ingrid and Evans Law Firm, Inc. 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. 

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

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