Dr. Nicholas L. DePace, a cardiologist, will receive $2.4M for his whistleblower lawsuit against Copper Health System and Cooper University Hospital over Medicare and Medicaid fraud allegations. He had accused the defendants of working with illegal kickbacks to recommend doctors via the Cooper Heart Institute Advisory Board.
The board’s supposed purpose was to have prominent doctors in New Jersey advise the institute about innovative management systems and technologies, as well as keep them apprised of the proper research and educational initiatives and the needs of the community. However, in his Qui Tam case, DePace contended that the board was a “sham” and that Cooper paid doctors that had big medical practices about $18,500/each to watch four lectures a year at a high-end banquet facility. Lectures included those that marketed cardiac care at Cooper, as well as other subjects unrelated to the board’s mission. DePace contends that the physicians did not provide any advisory services even though they were being paid.
Following a probe by the US Department of Justice and the New Jersey Attorney General’s Office, Cooper consented to pay $12.6M to settle the Medicaid/Medicare fraud accusations. However, the medical provider has been clear to note that it has not admitted to any wrongdoing, and the decision to resolve the dispute stemmed from wanting avoid lengthy litigation and all that comes with this.
Unfortunately, millions of dollars in US taxpayers’ money end up being wasted each year because ofMedicaid and Medicare fraud. While some in the medical business profit from such illegal activities, the rest of us suffer. Fortunately, the False Claims Act allows individuals that know about Medicaid/Medicare fraud to file a whistleblower lawsuit against the health care organization or professional that is perpetrating this scam. Depending on financial recovery, a whistleblower may be entitled to a percentage of that money.
Timing can be everything, and you want to make sure you are the one to bring forward whatever information is available about this illegal business practice. You should also keep this information confidential (limited disclosure could bar you from filing a complaint) and talk to a whistleblower fraud attorney right away.
Protections for Whistleblower Employees
Exposing Medicaid/Medicare fraud takes a lot of courage and, as a whistleblower, the False Claims Act affords employees who blow the whistle on an employer with certain rights, including protection from retaliation, firing, and other consequences on the job. If you are fired or put on leave for blowing the whistle, you may be entitled to compensation of double the wages that you lost.
Common Kinds of Medicaid and Medical Provider Fraud:
Double Billing: Billing twice for the same treatment—once to Medicaid and again to the patient or a private insurer. Or, two providers might try to get payment for the same exact procedure/services that were performed on a patient.
Billing for Services Not Rendered: Billing Medicaid for a procedure or service or treatment that wasn’t provided.
Billing for a brand drug when the less expensive, generic version was actually what was used.
Performing unnecessary services on a patient to be able to bill for them.
Kickbacks: A provider gives a “kickback” – gifts, money, products, etc.—in exchange for a referral from the other provider. Or, the kickback might be given in exchange for the use of services or products.
Upcoding: Billing for a more extensive service or a longer session than what was actually provided.
Unbundling: Taking a bundle of medical services that were provided to a patient and then billing for them separately.