In a recently settled qui tam case brought against a New York hematology-oncology practice, the whistleblower alleged that the practice spent years giving patients kickbacks while overcharging Medicare and Medicaid for their services. The state of New York and the U.S. government decided to get involved in the case, which was originally brought in April of 2014 as part of the False Claims Act, and they pursued the case together to its conclusion, in which the practice agreed to pay $5.3 million to resolve the allegations of health care fraud.
The whistleblower used to work as a billing representative for the practice and reported seeing things such as bills to Medicare that included copayments that had been waived due to financial hardship, and bills to Medicare for evaluation and management services that they couldn’t prove ever took place. As a result of this lawsuit and its outcome, the practice is now part of a corporate integrity agreement, under which they will be closely monitored, so that they can continue to participate in federal healthcare programs.
