The Kansas-based cancer center known as Hope Cancer Institute and one of its physicians recently settled with the U.S. government over allegations of fraudulent billing practices. In the healthcare industry alone, the False Claims Act has been pivotal in recovering billions of dollars on behalf of American taxpayers. In fact, in 2013 alone, the Department of Justice and several other agencies recovered $2.6 billion due to healthcare fraud whistleblower cases. If you are aware of possible fraud by your physician’s office or place of employment, we encourage you to read on about how you can play a role in recovering funds lost due to fraud and unlawful billing practices.
The False Claims Act and Healthcare Fraud
Healthcare fraud is the number one source of recovery under the False Claims Act. The FCA contains several important provisions allowing for private individuals to commence lawsuits alleging the submission of false claims to the federal government. At its discretion, the Department of Justice may opt to intervene and conduct its own investigation into the alleged misconduct. If a whistleblower lawsuit is successful, the plaintiff could receive up to 30 percent of the total amount recovered, regardless of whether recovery occurred due to a settlement or court order.
When it comes to healthcare fraud, the FCA applies in cases involving government-insured or subsidized patients receiving Medicare, Medicaid, or other federal healthcare benefits. For these patients, medical facilities and offices must submit claims on the patient’s behalf for reimbursement. If the claims are inflated, exaggerated, or false, this is considered a violation of the FCA and the entity or individual submitting the claim could face both criminal and civil penalties.
Details of United States ex rel. Turner et al. v. Hope Cancer Institute, et al.
In the Turner case, three former employees of the Hope Cancer Institute filed a lawsuit alleging faulty submissions to Medicare and Medicaid spanning from 2007 to 2011. More specifically, the plaintiffs (also known as relators or qui tam plaintiffs) alleged that the Institute and its owner Dr. Raj Sadasivan submitted claims for the chemotherapy drugs Rituxan, Avastin, and Taxotere that were never actually provided to patients. Allegedly, employees were told to bill the government for a predetermined dosage amount of these life-saving drugs when, in fact, patients were receiving a much lower dose. This practice resulted in routine and consistent inflated invoices to the federal government amounting to unlawful false claims in violation of the FCA.
“Healthcare providers that try to make a quick buck by billing taxpayers for services never provided will instead pay a high price for their greed-fueled fraud,” said Gerald T. Roy, Special Agent in Charge, U.S. Department of Health and Human Services Office of Inspector General. “We are dedicated to investigating and prosecuting these types of deceptive schemes.”
The DOJ has not released the amount recovered by the three whistleblowers.
Filing Your Own Lawsuit
Unfortunately, the billing practices explained above are not uncommon in the healthcare industry. If you are aware of a similar scheme or believe your doctor may be over-billing for your care, we encourage you to considering filing a whistleblower lawsuit today. For more information or to discuss your case, contact Berger Montague right away.