Former Employee Blows Whistle On Telemedicine Fraud
Criminal And Civil Prosecution Of Wrongdoers
Defendants Allegedly Submitted $400 Million In False Claims
The U.S. Department of Justice recently announced that the owner of a medical device maker has agreed to resolve criminal charges and civil claims arising out of false claims to the United States for braces and other durable medical equipment (DME). The civil case (known as a “qui tam” action) was initiated by a former employee of the device maker and brought under the False Claims Act (FCA), 31 U.S.C. § 3729 et seq. Under the qui tam provisions of the FCA, a private party can file an action on behalf of the United States and receive a portion of the settlement if the government takes over the case and reaches a monetary agreement with the defendant. The San Mateo County whistleblower attorneys at Evans Law Firm, Inc. represent employees, former employees, agents, and other persons with original information regarding fraud against the government and initiate their cases with the aim of an ultimate reward for their efforts if the government recovers. If you have information of fraud against the government, in the health care field or any other, call us today at (415)441-8669.
Allegations of Fraud
According to court documents, the individual business owner and accomplices used a straw company to establish dozens of other supply company fronts with trickery and deception. The scheme involved placing the DME fronts in the names of straw owners. By concealing the true ownership, the government alleged that the individual defendants secretly gained control of multiple companies. With such control, they collectively submitted well over $400 million in illegal DME claims to Medicare and the Civilian Health and Medical Program of the VA. According to the complaint, the conspirators claimed that the unusually high volume of claims reflected the use of telemedicine procedures, when, in fact, they had simply bribed doctors to approve them. Almost always, the doctors had no telehealth interaction with the beneficiaries according to the government. Following the filing of a qui tam complaint alleging this fraud, the government also opened a criminal investigation. The individual owner has entered into a plea agreement with the government, according to the DOJ. In addition to the criminal plea, defendants have agreed to a civil settlement of up to $20,332,516, to resolve allegations that they violated the False Claims Act in a number of ways, including falsifying documentation in order to fraudulently establish DME corporations to bill for medically unnecessary DME equipment, and engaging in improper marketing practices that violated the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b.
Employee Protection When Blowing The Whistle on Fraud
In the reported case, the whistleblower was a former employee of the device maker that allegedly defrauded the government. The former employee initiated her qui tam based on information she obtained firsthand during her employment. Sometimes, current employees witness government fraud on the part of their employers. The law protects them from retaliation from the employer for bringing a qui tam. 31 U.S.C.§ 3730(h)(1) reads:
Any employee, contractor, or agent shall be entitled to all relief necessary to make that employee, contractor, or agent whole, if that employee, contractor, or agent is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment because of lawful acts done by the employee, contractor, agent or associated others in furtherance of an action under this section or other efforts to stop 1 or more violations of this subchapter.
The relief can include reinstatement, back pay with interest, double pay, and compensation for special damages including recovering all attorneys’ fees and expenses for bringing an action. 31 U.S.C. § 3730(h)(2). The litigators at Evans Law Firm can represent you in an action for wrongful retaliation in addition to representing you in the underlying qui tam case.
Ingrid M. Evans and the other San Mateo County whistleblower and qui tam attorneys at Evans Law Firm can be reached at (415) 441-8669, or by email to <a href=”mailto:firstname.lastname@example.org”>email@example.com</a>. Our San Mateo attorneys 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.
 Evans Law Firm, Inc. was not involved in the case in any way. The qui tam case is captioned U.S. ex rel. Albright v. Regency, Inc., et al., No. 8:19-cv-686 (M.D. Fla.). Except for the conduct admitted in connection with the individual defendant’s criminal plea, the claims resolved by the civil settlement are allegations only, and there has been no determination of liability.