Two Health Care Providers Agree to Pay More than $20 Million to Settle Alleged False Claims Act Violations
The government’s crackdown on fraud has put the spotlight on the Anti-Kickback statute and others laws that are designed to maintain the integrity of the healthcare system. Thus earlier this month, the Justice Department announced that UPMC Hamot (Hamot) a Pennsylvania-based hospital affiliated with the University of Pittsburgh Medical Center (UPMC) and Medicor Associates, Inc. (Medicor), a cardiology practice, have agreed to pay $20.75 million to settle a False Claims Act lawsuit. The government alleges that the UMPC and Medicor knowingly submitted false claims to Medicare and Medicaid and that they violated the Anti-Kickback Statute.
The Anti-Kickback Statute (42 U.S.C. § 1320a-7b) prohibits offering, paying, soliciting or receiving remunerations to induce the referral of items and/or services covered by Medicare or any other federally funded program. The Physician Self-Referral Law (42 U.S. Code § 1395nn) – which Medicor and Hamot have also been alleged to have violated – prohibits hospitals from billing Medicare for services referred by physicians whom the hospital has an improper compensation arrangement. Both laws are intended to ensure that medical decisions are made on the basis of patient need and not upon financial incentives.
“Federal law prohibits physicians from entering into financial relationships that may affect their medical judgment and drive up health care costs,” said U.S. Attorney Scott W. Brady. “Today’s settlement demonstrates our commitment to ensuring that health care decisions are made based exclusively on the needs of the patient, rather than the financial interests of health care providers.”
The settlement sprung from a whistleblower action filed under the False Claims Act. Under the whistleblower provisions of the False Claims Act, private parties are able to sue for false claims with or without a false claims act lawyer and to share in any recovery. (A qui tam lawyer handles cases involving whistle blowing as it relates to the False Claims Act.) The original lawsuit alleged that from 1999 to 2010, Hamot paid Medicor 2 million per year to secure patient referrals. Some of these services were either repeated or were not performed.
“Financial arrangements that improperly compensate physicians for referrals encourage physicians to make decisions based on financial gain rather than patient needs,” said Acting Assistant Attorney General Chad A. Readler, head of the Justice Department’s Civil Division. “The Department of Justice is committed to preventing illegal financial relationships that undermine the integrity of our public health programs.” The whistleblower in this case is Dr. Tulio Emanuele. Emanuele worked for Medicor from 2001 to 2005. In March of last year the U.S. District Court for the Western District of Pennsylvania ruled that Hamot’s arrangements with Medicor did indeed violate the Physician Self-Referral Law (also known as the Stark Law). Dr. Emanuele will receive $6,017,500 as his share of the settlement.
Home Furnishings Company Agrees to pay $500,000 To Settle Alleged False Claim Act Violations
Although the False Claims Act has been used to expose Medicaid and Medicare fraud, it is also a handy tool for exposing fraud in other areas of government as well. Last month the Justice Department proved this when it announced that Home Furnishings Resources Group, Inc. (HFRG) has agreed to pay a half million dollar fine for violating the False Claims Act regarding its shipment of wooden bedroom furniture. The government alleges that the company did so to avoid playing anti-dumping fees from furniture imported from the People’s Republic of China (PRC). HFRG sells furniture that is heavily used in university student housing.
“The customs laws are intended to protect domestic companies and American workers from unfair foreign competition,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “This settlement shows our commitment to pursue those who violate these laws and gain an illegal advantage in U.S. markets by evading the import duties owed on foreign-made goods.” Brenda Smith, Executive Assistant Commissioner, Office of Trade, CBP added at the time, “CBP is committed to ensuring a level playing field for all American businesses. We work with our federal partners to hold accountable those looking to circumvent U.S. trade laws.”
The settlement with HFRG resolves allegations that the home furnishings company sought to evade anti-dumping duties on its wooden furniture that it’s important from the PRC between 2009 and 2014. HFRG did so by misclassifying the furniture as non-bedroom furniture on official documents. (Non-bedroom furniture was not subject to an anti-dumping duty at the time.) The anti-dumping laws are designed to protect foreign companies from “dumping” products on the US at prices below cost. These duties are collected and assessed by the Department of Commerce, the Department of Homeland Security and Customs and Border Protection (CBP). Wooden bedroom furniture imported from the PRC has been the subject of anti-dumping duties since 2004. At the time, the wooden furniture HFRG imported from the PRC was subject to a 216% anti-dumping duty.
The impetus for this settlement came from a lawsuit that was filed by University Loft Company, a competitor of HFRG, under the whistleblower provisions of the False Claims Act. This act permits private parties to sue for false claims and to share in any recovery. University Loft Company is slated to receive approximately $75,000 as its share of the recovery. The government has, since 2009, sought to aggressively pursue people and companies that are alleged to have committed fraud against its agencies. Individuals who report alleged acts of fraud are able to use a whistleblower law firm to protect their interest and to consult with a false claims act attorney. The government, through its actions against companies and individuals that have been accused of fraud, has recovered billions of dollars since 2009.
The United States Files False Claims Act Complaint Against Several Healthcare Providers and a Private Equity Firm Alleging Payment of Kickbacks
The government’s campaign to eradicate Medicare and Medicare (and sometimes TRICARE) fraud continues to net healthcare providers who stress financial considerations over patient well-being. This time the government’s pursuit of such alleged violators involves a marketer as well. The Department of Justice announced last week that it has filed a complaint against Diabetic Care Rx LLC, alleging that the compounding pharmacy located in Florida participated in an illegal kickback scheme involving TRICARE. (TRICARE is the federally-funded health care program for military personnel and their families.) In the same action, the government has also brought claims against Patrick Smith and Matthew Smith, two pharmacy executives, and Riordan, Lewis & Haden Inc. (RLH), a private equity firm based in Los Angeles, California, which manages both the pharmacy and the private equity fund that owns the pharmacy for their involvement in the scheme.
“The Department of Justice is determined to hold accountable health care providers that improperly use taxpayer funded health care programs to enrich themselves,” said Acting Assistant Attorney General for the Justice Department’s Civil Division Chad A. Readler. “Kickback schemes corrupt the health care system and damage the public trust.” The defendants are alleged to have paid kickbacks to marketing companies to target TRICARE beneficiaries for certain prescription medications without regard to patient need. According to the complaint, these prescriptions were manipulated to ensure the highest possible reimbursement from TRICARE. Moreover, the defendants and certain marketers allegedly paid doctors to prescribe these medications without seeing the patients. The scheme is thought to have generated tens of millions of dollars in reimbursements from TRICARE in a matter of months. Finally, the participants in this kickback scheme allegedly split the profit from these activities which violates the Anti-Kickback Statute (42 U.S.C. § 1320a-7b). This statute makes it illegal to exchange (or offer to exchange), anything of value, in an effort to induce (or reward) the referral of federal health care program business.
“The Defense Criminal Investigative Service (DCIS) is committed to protecting the integrity of TRICARE, the military health care program that provides critical medical care and services to Department of Defense beneficiaries,” said Special Agent in Charge John F. Khin, of the Southeast Field Office. “In partnership with DOJ and other law enforcement agencies, DCIS continues to aggressively investigate fraud and corruption to preserve and recover precious taxpayer dollars to best serve the needs of our war fighters, their family members, and military retirees.”
The government’s lawsuit originally arose from a lawsuit filed in the U.S. District Court for the Southern District of Florida by Marisela Medrano and Ada Lopez, two former employees of PCA. Their lawsuit was filed under the qui tam or whistleblower provisions of the False Claims Act. This Act permits private parties to sue for false claims and to share in any recover with or without a qui tam attorney. The Act also permits the United States to intervene in such lawsuits. This matter was investigated by several governmental and state agencies including the Civil Division’s Commercial Litigation Branch and the U.S. Attorney’s Office for the Southern District of Florida. Qui tam Medicare lawsuits have increased since the government began its crackdown on Medicare fraud and abuse.
Since this case has not yet been resolved, it is important to note that claims asserted against the defendants are allegations only and that there has been no determination of liability
Kentucky Physicians Agree to Pay Nearly $3 Million to Settle False Claims Allegations Related to Fraudulent Medical Claims
One problem of those who allegedly defraud government healthcare programs cause is that they divert resources from those who are in need. Thus, a spokesman for the Justice Department announced earlier this month that several otolaryngologists – Phillip B. Klapper, M.D., Patricia Klapper, and Phillip B. Klapper, P.S.C. (collectively, “Klapper”) – have agreed to pay the government a $2,791,758 settlement to resolve claims that the group improperly billed a federal healthcare program for audiological services and hearing aids. “Pursuing healthcare fraud is a priority of this Office and of the Department of Justice. We will continue to work with the Department of Labor and with other governmental agencies to ensure that fraudulent claims are investigated and those responsible are required to pay,” stated United States Attorney Russell M. Coleman. “Medical providers who overbill federal healthcare programs defraud the taxpayers and drive up the cost of healthcare for us all. Recovering taxpayer dollars lost to fraud helps keep strong those critical public healthcare programs so many people depend on,” said Coleman.
The United States alleged that the doctors, known as “Klapper”, knowingly submitted false claims which sought reimbursement for audiological procedures that were either not performed by certified personnel or that they altered in order to make the test results appear as if some claimants had hearing loss when indeed they did not. Moreover, the government contends that the doctors sought to exploit the Federal Employees’ Compensation Act. This act is the worker’s compensation program for federal employees. It is administered by the Department of Labor’s Office of Workers’ Compensation Programs.
Under the terms of the settlement agreement, Klapper has paid $2.79 million to settle the claims arising from such alleged conduct. Additionally, Klapper has agreed to be permanently banned from future participation in the Federal Employees’ Compensation Act program. The settlement came about as the result of a qui tam suit that was filed by Kimberly Cummings, a former employee of Klappers. Her lawsuit utilized the qui tam provisions of the False Claims Act. This law allows private individuals to sue for false claims on behalf of the federal government with or without a qui tam lawyer and to receive a share of any recovery. (Qui tam law firms, also known as “whistleblower” law firms, represent people who report alleged false claim violations.)
The matter was handled by Assistant United States Attorney L. Jay Gilbert, of the U.S. Attorney’s Office for the Western District of Kentucky, and the U.S. Department of Labor.
Healthcare Provider Agrees to Pay $1.5 Million to Settle Alleged False Claims Act Violations Involving Unauthorized Physical Therapy Services
Monies taken from vital programs such as TRICARE and Medicare are bound to raise the ire of the FBI as was demonstrated last month when it investigated a leading healthcare provider for such actions. A spokesperson for the Justice Department announced back in January that Scripps Health (Scripps), a health care system based in San Diego, agreed to pay $1.5 million to resolve charges that it violated the False Claims Act by charging government health care programs for physical therapy services that were rendered by therapists who did not have billing privileges to charge for these services. “Federal health care programs require that services are rendered by authorized providers or under the appropriate supervision of an enrolled physician,” said Acting Assistant Attorney General for the Justice Department’s Civil Division Chad A. Readler. “These requirements help protect patients from unscrupulous or unqualified medical professionals. The Department of Justice will continue to ensure that those who knowingly violate these requirements face appropriate consequences.” “Holding providers accountable protects patients and tax-payer funded health care programs,” said Eric S. Birnbaum, FBI Special Agent in Charge of the San Diego Field Office.
Specifically, the government alleged that Scripps billed Medicare and TRICARE for physical therapy services which were then provided by physicians who did not have billing privileges. The government also alleges that this was done without the appropriate supervision by a physician. “This settlement illustrates the United States Attorney’s Office’s continued commitment to protecting the integrity of the Medicare and TRICARE programs,” said U.S. Attorney Adam L. Braverman. “Unlawfully obtained payment from taxpayer-funded programs harms the entire health care system. We will hold accountable all providers who defraud these programs.”
The settlement came about as the result of a lawsuit that was filed by Suzanne Forrest, a former Scripps employee, under the qui tam provisions of the False Claims Act. These provisions permit private individuals to sue for false claims on behalf of the government. The qui tam provisions also allow private individuals who do file suit against alleged violators of the False Claims Act to share in any recovery. Claimants can do so with or without the aid of whistleblower lawyers or by using a qui tam law firm. As part of this settlement, Ms. Forrest will receive $225,000. The civil lawsuit was filed in the Southern District of California and is captioned United States ex rel. Forrest v. Scripps Health, Case No. 16-CV-0634.
Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
Tennessee Doctor Pays More than $1 million to Settle Alleged Violations of the False Claims Act
America has long been diagnosed with an opioid problem. This problem is exacerbated by physicians who inappropriately prescribe these painkillers to their patients. Thus, the Justice Department announced last week that a Tennessee-area chiropractor has paid $1.45 million, plus interest, to resolve allegations of False Claims Act violations. The settlement also calls for a pain clinic nurse practitioner to surrender her DEA registration and pay $32,000 because she allegedly violated the Controlled Substances Act. Four pain clinics managed by Matthew Anderson and his company PMC LLC – Cookeville Center for Pain Management; Spinal Pain Solutions in Harriman; Preferred Pain Center of Grundy County in Gruetli Laager; and McMinnville Pain Relief Center – are now closed as a result of this matter.
The medications Anderson is accused of having improperly billed Medicare include painkilling Opioids. “More Americans are dying because of drugs today than ever before—a trend that is being driven by opioids,” said Attorney General Jeff Sessions. “If we’re going to end this unprecedented drug crisis, which is claiming the lives of 64,000 Americans each year, doctors must stop overprescribing opioids and law enforcement must aggressively pursue those medical professionals who act in their own financial interests, at the expense of their patients’ best interests. Today’s settlement is a positive step that will help save lives, as well as protect taxpayers’ money, in Tennessee and across the United States.”
The government claims that from 2011 through 2014, Anderson and PMC encouraged pharmacies to submit requests for Medicare for pain killers including opioids for no legitimate medical purpose. The medications were written at the Cookeville Center for Pain Management. The government also contends that Anderson caused all four of his clinics to bill Medicare for office visits that were not reimbursable at the levels he claimed they should be. Finally, the government claims that Anderson and PMC caused the submission of Medicare claims by two nurse practitioners who were not participating with a physician as required by Tennessee law.
Under the terms of the settlement agreement, Anderson and PMC paid $1.45 million, plus interest. The government will receive the lion share of that amount while the state of State of Tennessee will receive more than $150,000. Anderson and PMC have also been excluded from billing federal health care programs for five years. Lastly, three of the clinics Anderson was involved with will forfeit $53,840 and have their bank accounts seized by the United States. A second part of the settlement agreement requires that Cindy Scott, a nurse practitioner from Nashville, to pay $32,000 to the government and to surrender her DEA registration until October of 2021.
The United States and Tennessee initiated their investigation of this matter after a former office manager for the Cookeville Center for Pain Management filed a qui tam lawsuit against Anderson, et al. The qui tam, or whistleblower, provisions of the False Claim Act allows private citizens – with or without a qui tam attorney – to sue on behalf of the government and to share in any recovery. The whistleblower will receive $246,500 under the settlement.
Kmart Agrees to Pay the Government More than $32 million to Resolve Claims that it Overbilled Medicare and Medicaid
As 2017 came to an end we saw the government continue its efforts at pursuing entities and individuals that violate healthcare programs such as Medicaid and Medicare. Even large, multinational corporations were not immune from the long arm of government prosecutors. This was demonstrated when late last month Kmart Corporation agreed to pay $32.3 million to settle allegations that it – through its in-store pharmacies – failed to report discounted drug prices to Medicare Part D, Medicaid and TRICARE beneficiaries and their families. The government says that these activities amount to overbilling for these healthcare programs. Moreover, the government also alleges that Kmart violated the False Claims Act by engaging in such behavior. The settlement resolves allegations that were brought about under the qui tam or whistleblowers provisions of the False Claims Act. Under this provision, private citizens are able to sue on behalf of the United States for False Claims Act violations. Specifically, it is alleged that Kmart’s pharmacies offered discounted generic drug prices to customers who paid with cash then knowingly failed to disclose those discounted prices to Medicare, Medicaid and TRICARE. (TRICARE is a health program designed to assist uniformed service members and their families.)
“Pharmacies and other providers who receive funds from taxpayers have a duty to follow the law,” said U.S. Attorney Donald S. Boyce for the Southern District of Illinois. “If healthcare providers do not provide fair and transparent pricing as required under the law, the False Claims Act allows the government and whistleblowers to ensure that the Medicare, Medicaid, and TRICARE programs are made whole.” The original lawsuit dates back to 2008 and was initiated by James Garber and was later later transferred to the Southern District of Illinois. Garber is expected to receive $9.3 million as his share of the recovery. The settlement agreement is part of a global $59 million settlement against Kmart which includes state Medicaid claims against the corporation.
“Pharmacies that are not fully transparent about drug pricing can cause federal health programs to overpay for prescription drugs.” said Acting Assistant Attorney General Chad A. Readler for the Department’s Civil Division. “This settlement should put pharmacies on notice that there will be consequences if they attempt to improperly increase payments from taxpayer-funded health programs by masking the true prices that they charge the general public for the same drugs.” The case is one of the many examples of the government’s emphasis on combating health care fraud. One tool it uses often uses to do this is the False Claims Act.
State-of-the-Art Cancer Treatment Provider Agrees to Pay $26 Million to Settle Alleged False Claims Act Violations
The number of many physicians who are incentivized to enter into illegal financial arrangements with health care providers is still quite alarming despite the government’s ongoing campaign against such actions. This was demonstrated earlier this month when the Department of Justice announced that 21st Century Oncology Inc – an integrated cancer care provider based in Florida – and several of its affiliates and subsidiaries have agreed to pay $26 million to settle charges that it electronically submitted false claims to Medicare in violation of the False Claims Act and that it engaged in improper financial relationships with several physicians. “The Justice Department is committed to zealously investigating improper financial relationships that have the potential to compromise physicians’ medical judgment,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “However, we will work with companies that accept responsibility for their past compliance failures and promptly take corrective action.” 21st Century Oncology, which operates several facilities throughout the United States, employs physicians in several specialty fields including radiation oncology, medical oncology and urology.
The settlement reached between the United States and 21st Century Oncology resolves behaviors that the company engaged in and eventually disclosed to the Justice Department involving the Medicare Electronic Health Records (EHR) Incentive Program. The Medicare EHR Incentive Program is designed to help physicians to receive incentive payments and avoid downward adjustments in certain Medicare claims. This is only to be the case when physicians can attest to the meaningful use of certified EHR technology. 21st Century Oncology disclosed that it knowingly submitted false attestations to CMS concerning employed physicians’ use of EHR software. The company further disclosed that it falsified data regarding the use of EHR software, made up utilization reports and that it copied EHR vendor logos onto reports in order to make them appear to be legitimate.
“This settlement represents our office’s continued commitment to ensuring compliance with important federal health care laws,” said Acting U.S. Attorney Stephen Muldrow of the Middle District of Florida. “We appreciate that 21st Century Oncology self-reported a major fraud affecting Medicare, and we are also pleased that the company has agreed to accept financial responsibility for past compliance failures.” In addition to False Claims Act violations, the settlement also resolves allegations that 21st Century Oncology violated the physician self-referral law also known as “Stark Law.” The Stark Law prohibits physicians from referring patients for certain designated health services paid for by Medicare to any entity in which they have a “financial relationship.” The government alleges that 21st Century Oncology violated this law by submitting claims for services performed pursuant to referrals from physicians whose compensation did not satisfy any exception to the Stark Law.
The Stark Law allegations were brought about as the result of a lawsuit that was filed by Matthew Moore, 21st Century Oncology’s former Interim Vice President of Financial Planning under the qui tam provisions of the False Claims Act. Under this Act, private parties are allowed to sue for false claims on behalf of the government and to share in any recovery. Mr. Moore will receive $2 million as his share of the recovery. 21st Century Oncology has also agreed to enter into a five-year Corporate Integrity Agreement (CIA) with the Office of Inspector General of the United States Department of Health and Human Services (HHS-OIG) as part of the settlement. The CIA obligates 21st Century to undertake certain compliance reforms and to hire an organization to conduct an independent review of its practices.
EmCare Inc. (EmCare) and Physician’s Alliance Ltd (PAL) Agree to Pay More than $33 Million to Resolve Stark Law Violations
The government has demonstrated once again that it will not tolerate physicians who make medical decision based solely on financial considerations. This was illustrated when the Department of Justice announced earlier this month that two physician’s groups – EmCare Inc. and Physician’s Alliance Ltd (PAL) – have agreed to pay $29.6 million to resolve allegations that from 2008 through 2012 the companies referred patients to hospitals owned by Health Management Associates (HMA) in exchange for remuneration. The companies are alleged to have recommended that patients be admitted to HMA-run hospitals on an inpatient basis when they should have been admitted on an outpatient basis only. Medicare pays three times as much for inpatient submissions as it does for outpatient care. As part of the scheme, HMA is alleged to have made certain bonus payments to EmCare Emergency Department (ED) physicians and tied EmCare’s retention of existing contracts to increased admissions of patients who came to the ED.
In a separate agreement, three PAL executives have agreed to resolve allegations that from 2009 until 2012, the company accepted illegal remuneration from HMA to refer patients to two HMA hospitals. Under the terms of the agreement, PAL and its executives will have to pay $4 million plus interest of proceeds from the sale of PAL’s interest in a joint venture with HMA. “These settlements demonstrate our commitment to ensuring that physician judgment is not compromised by illegal inducements,” said Acting Assistant Attorney General for the Justice Department’s Civil Division, Chad A. Readler. “Patient care decisions should be based on the needs of patients rather than the financial interests of physicians.”
Under the terms of the settlement, Envision Healthcare Corporation (Envision) has entered into a Corporate Integrity Agreement (CIA) with the Department of Health and Human Services Office of Inspector General. EmCare is a subsidiary of Envision. “This settlement is a direct result of the FBI’s dedication to hold companies accountable for their role in healthcare fraud and abuse, and it would not have been possible without the teamwork between FBI Atlanta, the FBI Headquarters’ Major Provider Response Team, DOJ, and our partners,” said FBI Assistant Director Stephen E. Richardson. “Since 2011, the FBI and our partners have returned over $1.25 billion to private and public healthcare programs from these “whistleblower” investigations. The FBI is committed to safeguarding the public’s trust in a health care system that places patient care, not financial gain, as their primary focus.”
The EmCare settlement was reached as a result of a qui tam lawsuit which was filed by Drs. Thomas Mason and Stephen Folstad. Under the qui tam provisions of the False Claims Act private individuals are able to sue on behalf of the government for false claims and to share in any recovery. Drs. Mason and Folstad will receive more than $6 million. In a separate action, two former HMA executives filed suit in court alleging that a scheme between PAL and HMA existed. The two executives’ share of the settlement has not been determined.
Nationwide Pharmacy to Pay $63.7 Million to Settle Alleged Medicare Fraud
The government’s efforts at combating healthcare fraud often serve to maintain the very integrity of programs such as Medicare, Medicaid, etc. A breach in Medicare was corrected last week when the Justice Department announced that DaVita Rx – a nationwide pharmacy based in Coppell, Texas – has agreed to pay $63.7 million to resolve claims related to improper billing practices and unlawful financial inducements to healthcare program beneficiaries. The Texas based pharmacy specializes in serving patients with severe kidney disease. DaVita is alleged to have billed federal healthcare programs for prescription medications that were not shipped, that were shipped and later returned and that were shipped without the proper documentation. DaVita is also alleged to have paid financial inducements to Federal healthcare program beneficiaries. This is a violation of the Anti-Kickback Statute (42 U.S.C. § 1320a-7b). The nature of the kickback allegations are that DaVita accepted manufacturer copayment discount cards in lieu of collecting copayments from Medicare beneficiaries. DaVita is also said to have written off unpaid beneficiary debt and extended discounts to beneficiaries who paid for their medications using their credit card. The allegations came about as a result of self-disclosures by DaVita Rx and a whistleblower lawsuit.
“Improper billing practices and unlawful financial inducements to health program beneficiaries can drive up our nation’s health care costs,” said Civil Division Acting Assistant Attorney General Chad Readler. “The settlement announced today reflects not only our commitment to protect the integrity of the healthcare system, but also our willingness to work with providers who review their own practices and make appropriate self-disclosures.” According to the government, DaVita has already repaid approximately $22.2 million to federal healthcare programs following its self-disclosure and is slated to pay an additional $38.3 million as part of the settlement agreement. Additionally, $3.2 million has been allocated to cover Medicare program claims by states who may chose to participate in the settlement. “Providers should not make patient care decisions based upon improper financial incentives or encourage their patients to do the same,” said U.S. Attorney Erin Nealy Cox for the Northern District of Texas. “The U.S. Attorney’s Office has and will continue to work cooperatively with providers that bring such issues to light to redress the losses the federal healthcare system has incurred.”
The settlement came about as the result of a suit that was filed by two former DaVita Rx employees, Patsy Gallian and Monique Jones, under the qui tam, or whistleblower, provisions of the False Claims Act. These provisions permit private individuals to sue on behalf of the federal government and to share in any recovery. The whistleblowers in this case will receive approximately $2.1 million from the federal recovery. The settlement of this case illustrates the government’s ongoing efforts at combating healthcare fraud. One tool it uses is the False Claims Act and the whistleblower provisions of that act. The Department of Health and Human Services offers several programs for health care providers to self-report potential fraud.