3 Whistleblowers Receive Almost $3 Million in Radiology Group Medicare Fraud Scam
The Department of Justice announced it has fined Diagnostic Imaging Group $15.5 million after finding the company had billed Medicare for radiology services that were not preformed. The government also claims the company paid illegal kickbacks to doctors. The penalties are the result of whistleblower cases filed in New Jersey and Brooklyn. Under the terms of the federal False Claims Act, the whistleblowers will receive a combined total reward of $2.8 million.
Diagnostic Imaging Group (DIG) operates a chain of diagnostic imaging facilities in New York under the name Doshi Diagnostic Imaging Services. Previously the company operated facilities in New Jersey and Florida under the Doshi name and also Signet Diagnostic Imaging Services.
According to the complaints originally filed by the whistleblowers, DIG submitted false claims to Medicare as well as the New Jersey and New York Medicaid programs. The complaint says that the programs were billed for CT scan services never performed. In addition, the company also “bundled” services so as to force physicians to order medically unnecessary services.
In some cases, the company paid kickbacks to doctors who referred patients.
Today, kickbacks are rarely envelopes filled with cash. In this case, prosecutors say the kickbacks were in the form of payments that DIG made to physicians ostensibly to supervise patients who underwent nuclear stress testing. These payments allegedly exceeded fair market value and were, in fact, intended to reward physicians for their referrals.
Although not part of this case, we have seen other radiology fraud cases involving sending images overseas to be read and not having a physician on premises when doing contrast studies (injection of die). Medicare fraud by imaging centers and radiologists is unfortunately quite common these days.
All three cases were filed under the False Claims Act, a law that dates back to the Civil War. That law allows ordinary people to file a lawsuit in the name of the government and collect a piece of the recovery.
In announcing the successful prosecution of DIG, the U.S. Attorney for the Eastern District of New York, Loretta Lynch, said “Patients deserve testing decisions based solely on medical need, not doctors’ pocketbooks. We will continue to work with our federal and state law enforcement partners to investigate vigorously allegations of fraud on federal programs like Medicare and to pursue those who seek to fraudulently deplete the Medicare Trust Fund.”
Lynch’s New Jersey counterpart, Paul Fishman, had similar comments, “Health care providers who make decisions based on profit instead of medical need compromise patient safety and confidence. Unnecessary tests and the payment of kickbacks also siphon precious resources from our health care system.”
How to Obtain a Whistleblower Reward
The government pays out hundreds of millions of dollars in reward monies each year to whistleblowers. Many of the largest fraud cases were started by whistleblowers. The Justice Department says these folks save taxpayers billions of dollars each year.
To qualify as a whistleblower under the False Claims Act, a person generally needs three things:
1) Knowledge of fraud involving a government funded program. Medicare fraud claims are the most common false claims act cases but they are by no means the only ones. Bank and mortgage fraud (FDIC, TARP and Fannie Mae / Freddie Mac loan guaranties), defense contractor fraud and government projects built with foreign goods are also common sources of whistleblower lawsuits.
2) The knowledge of the fraud must be “original source”. To qualify, you must have first hand and direct knowledge of the fraud. This means if you read about the fraud online, it is probably too late. You are most likely not the “original” source.
3) A great whistleblower lawyer. Receiving a False Claims Act whistleblower award requires filing a lawsuit under seal in federal court. There are several lawyers that know how to file such a suit but choosing the right lawyer may mean the difference between a multi-million check and the government not understanding or pursuing your case.
There are also reward programs for people with inside knowledge about tax fraud (IRS whistleblower program), fraud involving corporate books and records or securities (SEC whistleblower program), bank fraud (FIRREA rewards) and even bribery of foreign government officials. We can help you navigate all of these programs.
Since 2009, the federal government has collected tens of billions of dollars through whistleblower cases. $20 billion of that total has involved Medicare fraud.
If you want more information about whistleblower rewards, visit our whistleblower FAQ page. Ready to see if you have a case? Contact us online, by email or by phone 202-800-9791. Let one of our experienced whistleblower lawyers evaluate your case. No obligation, no fee and in strict confidence, of course.
We have successfully represented many whistleblowers including in the largest civil recovery in US history, the historic $16.67 billion case against Bank of America.
Mahany Law – America’s Whistleblower Lawyers. Services provided nationwide.
(whistleblower photo courtesy of Dave Winer – scripting news)