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Nov 28, 2021 by |

San Mateo County Whistleblower Attorney: $3.9 Million Settlement Of Allegations Of Billing For Unnecessary Tests

ATTORNEY NEWSLETTER

Allegations Of Excessive And Unnecessary Testing

Physician Group Allegedly Overbilled For In-House Laboratory

Two Former Office Staff Members Blew Whistle 

Every year private individuals recoup more money for the government lost to fraud f than the government itself does. Last year alone, of the $2.1 billion recovered by the government from wrongdoers, over 80% came from actions brought by private individuals against those businesses perpetrating the fraud.  Any individual with knowledge of fraud against the government is authorized to bring an action on behalf of the government to recover money paid out on fraudulent claims. See False Claims Act (FCA), 31 U.S.C. §§ 3729 et seq.  These cases are known as “qui tams” and the plaintiffs are referred to as “relators.” Relators can be rewarded 15-30% of the amounts and penalties recovered. 31 U.S.C. § 3730(d).  Much of the fraud occurs in the healthcare industry.  If you have credible information of false healthcare claims in San Mateo County 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).

Unnecessary Testing Case Settlement

On October 22, 2021 U.S. Department of Justice (DOJ) announced two settlements totalling $3.9 million with a physicians group for allegedly charging the government for unnecessary testing of patients.[1]  The settlements resolve allegations that the physicians, formerly co-owners of a pain management practice, knowingly caused the submission of false claims to federal healthcare programs by ordering excessive and unnecessary urine drug testing for patients without any individualized assessment of clinical need. All drug tests ordered by the group were performed at their in-house laboratory, according to the government. The DOJ alleged that the two individual defendants drafted the testing protocols that resulted in unnecessary tests, were aware that the in-house laboratory was conducting an excessive number of tests on urine samples, and that the practice could not remain profitable without the income generated from unnecessary testing. The whistleblowers in the case were two former employees of the physicians’ group and will receive 15-30% of the $90 million settlement as a reward for blowing the whistle on the defendant’s practices.  Her qui tam suit was originally filed six years ago.

How A Qui Tam Case Begins

Qui tam cases begin with filing a complaint under the FCA in the federal district court where the allegedly fraudulent conduct occurred.  31 U.S.C. § 3730(b).  The complaint is filed confidentially under seal and the government has sixty days to review the allegations and decide whether to intervene.  This review period can be extended, and often times is, for a year or more as the government continues to investigate the allegations.  If the government decides to intervene, as in the reported case, 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 were fired or demoted as a result of blowing the whistle.  31 U.S.C. § 3730(h).

Contact Us

If you have credible information of healthcare fraud against the government here in San Mateo County or elsewhere in California, 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 whistleblower cases, Ingrid also handles 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 cases in any way.

 

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