This past December, the Department of Justice (DOJ) announced that 21st Century Oncology (21st Century) agreed to pay $19.75 million to settle False Claims Act (FCA) allegations. 21st Century, a nationwide provider of cancer care services, was alleged to have violated the FCA by billing Medicare for tests that were unnecessary.
The government alleged that 21st Century was submitting claims to Medicare for unnecessary fluorescence in situ hybridization (FISH) tests. FISH tests are urine tests that detect abnormalities associated with bladder cancer. The government alleged that 21st Century encouraged physicians to order these unnecessary tests by providing bonuses, which were based on the number of tests referred.
The monies Medicare used to reimburse 21st Century for these tests were tax dollars collected and set aside for the purpose of assisting health care. The government has been waging war against health care fraud, and, as Principal Deputy Assistant Attorney General Benjamin Mizer stated, “Providers who waste taxpayer dollars by billing for unnecessary services will face serious consequences.”
The FCA is a powerful tool that the government utilizes in its war against health care fraud. One of the reasons the FCA is so powerful is it contains a qui tam (whistleblower) provision, which allows citizens to sue on behalf of the government when a party is committing fraud against the government. This provision helps the government detect more fraud as individuals do the right thing by blowing the whistle on fraud. The suit against 21st Century was originally filed under this provision of the FCA by a former 21st Century medical assistant.
The qui tam provision of the FCA provides incentives for whistleblowers, which include 15 to 30 percent of the funds recovered. For example, in this case against 21st Century, the whistleblower will receive $3.2 million for their part in the case. These whistleblower incentives continue to help the government (1) detect more fraud, (2) ensure money intended for health care is properly spent on health care, and (3) deter other companies from committing the same fraud.
The government has prominently shown its desire to combat health care fraud. If you’re aware of fraud being committed against the federal or state governments, you could be rewarded for doing the right thing and reporting the fraud. If you have any questions about whether you qualify as a whistleblower, please contact an attorney at Beasley Allen for a free and confidential evaluation of your claim.
Source: U.S. Department of Justice