Ordinary people who report doctors or corporations which commit fraud can be paid very well for their efforts. In 2013 alone, $3.8 BILLION was recovered by the U.S. government, and the PEOPLE WHO REPORTED FRAUD WERE PAID $345 million. $2.6 BILLION recovered in 2013 was from healthcare fraud. Ordinary Americans reported unscrupulous doctors and corporations which charged for medical services and products which were never delivered. Some who reported fraud were health care workers, including physicians, nurses, and technicians. Some were patients. This fraud on our government affects us all. I am privileged to have represented some of those patriotic Americans reported fraud and were paid well.
In one example, the fraud involved different doctors in different states who charged for services which they did not perform amounting to tens of millions of dollars. “Dr. A” owned ten Varicose Vein clinics in Illinois, California, Massachusetts, and New York, which had slick advertisements on television, in magazines, and on the internet, promising to eliminate ugly varicose veins. Treatments and medical procedures done in doctor’s office, like procedures to treat varicose veins of the legs, are rarely scrutinized, overseen, or regulated by state agencies. Dr. A hired other doctors and nurses to work in his ten different clinics, many of whom had little or no experience in performing the procedures in which a tube is inserted into the varicose vein under local anesthesia. A laser or similar device is then activated, which causes scarring and obliteration of the varicose vein.
Dr. A charged tens of millions of dollars for personally performing these procedures. This were fraudulent charges, because his employees, doctors and nurses, some of whom were not even licensed to practice medicine, actually did these procedures. Dr. A was not even in the state when they were performed. Medicare and insurance companies paid Dr. A millions of dollars for procedures not done at all. Most were not done by Dr. A. Not surprisingly, in many cases the procedures were negligently done, and the patients burned and injured.
The person who reported this fraud by Dr. A, known as the “whistleblower” or the “relator,” was a technician, who worked in one of Dr. A’s offices. This courageous American contacted me, and we collected evidence of the fraud. We filed a lawsuit and turned it over to the U.S. Attorney. The FBI investigated Dr. A’s fraud, office computers were seized, and the case successfully prosecuted, earning my client a handsome award.
In California, the whistleblower who reported the fraud to us was himself a doctor. Over a period of years, Dr. B defrauded Medicare and insurance companies for fraudulently charging for procedures he did not do. The whistleblower learned of the fraud because he treated the injuries caused by Dr. B. The whistleblower learned that Dr. B was charging for procedures he did not perform. Dr. B performed a less expensive procedure, but charged for the more expensive one. B charged for a procedure known as RF Ablation, or radio-frequency ablation, in which the Vein Clinic operator is paid approximately $300 more than if the procedure is done with a laser. The whistleblower doctor learned that Dr. B was charging for a procedure which required an device Dr. B did not possess. The whistleblower learned of the fraud when he reviewed the insurance benefits statement of patients of Dr. B, who came to the whistleblower for treatment of Dr. B’s complications. He verified with a manufacturer’s representative that Dr. B did not own the more expensive RF device, which was confirmed when he hired two of Dr. B’s former employees. Over a period of years, Dr. B was paid millions of dollars for procedures he never performed. This courageous doctor contacted me. We interviewed witnesses and collected convincing evidence of the fraud. We filed a whistleblower lawsuit, and U.S. Attorney took the case. The FBI investigated Dr. B’s fraud. The case earned my client a handsome award.
The Patient Protection and Affordable Care Act of 2010 (“Affordable Care Act”), also known as ObamaCare, provides amends the False Claims Act (“FCA”) and makes it easier for whistleblowers to be paid for reporting fraud against our government. The FCA provides that a person or corporation which knowingly submits a false claim to the government may be held liable for triple damages. Private whistleblowers, known as “relators,” may bring a suit on behalf of the government pursuant to the FCA, called a “qui tam” suit, and, if successful, share in the recovery. The relator’s portion of the recovery varies based upon the Department of Justice’s involvement in the case. In the 2013, FCA settlements and judgments totaled $3.8 billion. Healthcare fraud was the main source of recovery for qui tam claims, totaling $2.6 billion.
If you have knowledge of a person or corporation systematically defrauding the government, call us. If we take your case, you may recover millions of dollars, help prevent fraud, and save the government millions of dollars. Contact Kenneth C. Chessick, MD, JD at KCC@Cliffordlaw.com or 847-843-8044.