Fraud in the healthcare industry is reaching alarming levels. Each year, the Department of Justice works in concert with several other federal agencies and state-level counterparts to combat this growing trend. The False Claims Act is extremely pivotal in bringing healthcare fraud to light. Given the widespread problem of fraud on the government, it is virtually impossible for federal authorities to monitor and oversee every bill and invoice submitted to Medicare and Medicaid for reimbursement. Therefore, authorities rely on the integrity of private citizens to recognize, report, and prosecute healthcare fraud when they see it – often resulting in sizable rewards for plaintiffs willing to come forward with their allegations.
In a recent settlement with the federal government and the governments of New York and New Jersey, a seemingly successful imaging center was forced to pay an enormous settlement in response to a whistleblower lawsuit alleging years of fraud against Medicare and Medicaid. Fortunately for citizens of these states, as well as all federal taxpayers, the imaging group was forced to submit to a corporate integrity agreement, which will basically disallow it from continuing similar fraudulent practices in the future.
Details of United States v. Doshi Diagnostic Imaging and Diagnostic Imaging Group
The defendant in today’s case, Doshi Diagnostic, is a medical corporation engaged in the business of outpatient imaging services including ultrasounds, mammography, radiology services, and nuclear medicine. It serves patients in the Long Island and New Jersey areas and has been in business for several decades.
According to allegations submitted by three former employees pursuant to separate whistleblower complaints, Doshi Diagnostic and its subsidiary Diagnostic Imaging Group LLC, engaged in the routine practice of submitting claims to Medicaid and Medicare for patient imaging services that were not medically necessary or not actually ordered by a referring physician. Under Medicaid and Medicare laws, a patient may only be reimbursed for services that are necessary to the care and treatment of an underlying condition. Medically unnecessary or elective services are not covered by these programs. Doshi also allegedly provided kickbacks to physicians based on the number of referrals for diagnostic imaging the particular doctor was able to procure – another practice specifically outlawed by the FCA.
Under the terms of the settlement, the federal government is to receive $13.65 million while the states of New York and New Jersey received $1.85 million. The three whistleblowers in the case reportedly earned rewards totaling $2.77 million.
Federal and state governments work tirelessly to fight the growing problem of healthcare fraud. In a statement, New York Attorney General Eric Schneidermain said, “Fraud committed by medical practices costs New York taxpayers millions of dollars every year… My office will find those who cheat the system, cheat New York taxpayers, and cheat our most vulnerable patients. In addition to other fraud, these companies were suspected of paying kickbacks. This illegal behavior must – and will – stop.”
Talk to a Whistleblower Attorney Today
If you are considering a whistleblower lawsuit or believe you may have information about healthcare fraud, we encourage you to meet with a whistleblower attorney as soon as possible. As in the above case, whistleblowers stand to earn a sizable reward from successful cases and oftentimes receive as much as 30 percent of the total settlement or verdict.