The qui tam provisions of the False Claims Act have been used to recover billions of taxpayer dollars taken through all sorts of health care fraud schemes against the Medicare, Medicaid, Federal Employees Health Benefits Plan (FEHBP), the Veterans Administration, TRICARE and other public health programs. For over 20 years, Vogel, Slade & Goldstein attorneys have been successfully representing qui tam whistleblowers in health care fraud cases.
There are many different kinds of health care fraud schemes. For example, a provider might be "upcoding" services, i.e., billing for a higher, more expensive level of medical services than what was actually delivered. Or, a provider, such as a hospital or physician, might be rendering health care services that were not medically necessary or appropriate, and billing these services to a Government insurance program. Conversely, in long term care settings in which providers are paid a daily rate to deliver all care necessary to treat their patients, a provider may systematically fail to deliver medically necessary care to its patients.
another type of fraud occurs when a provider bills a Government program for health care services which were provided to beneficiaries, but which should not have been paid for by Medicare or Medicaid because the provider was violating an important rule, such as the Anti-Kickback Statute or the Stark Law, against self-referrals, or the prohibition against "Off-Label Marketing" of drugs, i.e., marketing them for uses which haven't been approved by the FDA and might be harmful to patients. Or, drug manufacturers or pharmacy chains might be violating pricing rules and, consequently, overcharging the Government.
Providers also can defraud the Government by knowingly billing for services provided to patients who do not qualify for treatment under Government healthcare programs. For example, a hospice provider may violate the False Claims Act by systematically submitting claims to Medicare for patients who were not terminally ill when admitted and therefore did not qualify for hospice care.
VS&G’s Experience in Health Care Fraud Cases
Vogel, Slade & Goldstein attorneys have successfully handled numerous health care fraud cases involving these types of schemes, as well as many others, against many of the largest companies in the health care sector, including:
Tenet Healthcare, Inc., operator of the nation’s second largest health care chain at the time, paid more than $900 million to settle claims in multiple qui tam lawsuits that it had over-billed Medicare through use of an overstated “cost-to-charge” ratio that inflated “outlier” and other cost-based payments sought by this hospital chain.
Fresenius Medical Care North America, a pharmaceutical company, paid $385 million to settle civil claims in multiple qui tam lawsuits that a predecessor company, National Medical Care, Inc., paid unlawful kickbacks to induce physicians and nurses to provide unnecessary intravenous nutrition to dialysis patients covered by Medicare.
HCA, Inc., the nation’s largest hospital chain at the time, paid $225.5 million to resolve claims by multiple qui tam plaintiffs that HCA unlawfully paid kickbacks to physicians, and violated the federal “Stark” law, to induce physicians to refer patients whose care would be billed to federal health programs.
Omnicare, Inc., the nation’s largest long term care pharmacy chain, paid $98 million to settle allegations that drug manufacturers paid kickbacks to Omnicare so that the pharmacy chain would prefer their products over competing products when recommending products to nursing home patients, and that Omnicare paid kickbacks to nursing homes to secure their business. The settlements were based on allegations by four whistleblowers, including a firm client.
Omnicare, Inc., paid $49.5 million to settle allegations in two qui tam whistle blower actions that it switched patients’ medications without physician approval in order to maximize Medicaid reimbursement.
LifeScan, Inc., a medical device manufacturer, paid $30.6 million to settle allegations in a qui tam action that it sold defective blood glucose monitors to Medicare patients and failed to report adverse events to the FDA.
Emergency Physicians Billing Services, a billing company based in Oklahoma City, paid over $28.8 million to resolve allegations in a qui tam lawsuit that it was systematically upcoding claims and overcharging the Government for emergency physician services.
BlueCross/Blue Shield of Michigan, the fiscal intermediary for Medicare in Michigan, paid $27.6 million to settle qui tam claims alleging that it cheated on quality control tests in order to misrepresent the quality of the auditing services it was providing for the Medicare program.
Omnicare, Inc. paid more than $20 million to resolve allegations made by a firm client that the pharmacy chain knowingly overbilled the Medicaid programs of Massachusetts and Michigan as a result of its failure to comply with “usual and customary charge” billing rules.
Ivax Pharmaceuticals, a manufacturer of generic medications, paid $14 million to resolve claims by a firm client that it paid kickbacks to become Omnicare’s exclusive supplier of certain generic medications.
Blue Shield of California, a Medicare carrier, paid $12 million to settle allegations in a qui tam action that it misrepresented the quality of claims processing services it was providing for the Medicare program.
UroCor, Inc., and Dianon Systems, Inc., medical laboratories, paid $9 million and $4.8 million, respectively, to resolve qui tam lawsuits alleging that they billed Medicare for medically unnecessary lab tests that physicians did not know they were ordering.
Adventist Health System Sunbelt Healthcare Corporation, a hospital system, paid $8.7 million to resolve claims in a qui tam case that it overcharged Medicare for ambulance services.
NIPSI, a pharmacy company, paid over $7 million to resolve allegations in a qui tam case alleging that it overstated the cost of intravenous drugs.
Florida radiologist Fred Steinberg paid $7 million to settle claims in a qui tam lawsuit that he billed Medicare for medical imaging tests that were not ordered and were medically unnecessary.
Home Americair of California, Inc., a durable medical equipment company that supplied home oxygen, paid $5 million to the Government to settle claims in a qui tam case that it used false records to support claims to Medicare.
Blackstone Medical Inc., a medical device manufacturer, and orthopedic surgeon Patrick Chan, paid $3.3 million to settle allegations in a qui tam action that Blackstone paid kickbacks to surgeons who used Blackstone products.
Drew Medical Center, Inc., a Florida diagnostic radiology company, agreed to pay approximately $1.5 million to resolve claims in a qui tam suit that it systemically charged Medicare for venograms although the company was not performing those procedures.
If you have information about health care fraud and you would like to speak with a VS&G attorney about a potential qui tam False Claims Act case, please feel free to contact us directly or click on the “Contact Us” link. VS&G will conduct an initial, confidential consultation about potential legal representation without any obligation or fee.