Medicare fraud cases are unfortunately commonplace. One of the most common types of case involves overbilling. Usually these claims are brought directly against the provider. A recent settlement involving Covidien PLC subsidiary EV3 is unusual because prosecutors sought to hold a third party responsible for over billing. The government claims that EV3 wrongly duped hospitals into overcharging Medicare.
Earlier this month the Justice Department settled a case brought by a whistleblower against EV3 for $1,250,000.00. The suit claimed that the company instructed hospitals to bill a surgical procedure that removes plaque buildup in blood vessels as an inpatient procedure when it should have been billed as a less costly outpatient procedure.
Usually, Medicare fraud claims alleging overbilling are brought directly against hospitals and clinics. In this case, however, company sales reps were falsely telling hospitals they could bill Medicare for the surgery using their device as an inpatient procedure. The company thought more hospitals would buy their surgical device if the hospitals believed they could receive higher reimbursements. Medicare experts claimed that most patients could be treated as outpatients.
The whistleblower in this case was a former district sales manager for the company. She claimed the company used a “coordinated, nationwide marketing strategy” of falsely telling hospitals that patients should receive treatments on an in-patient basis even though there was no medical necessity to do so. The result was overcharges to the taxpayer funded Medicare program. EV3’s actions not only increased healthcare costs but also caused some patients to be inconvenienced.
In settling the case, the company did not admit any wrongdoing
For her role in bringing the Medicare fraud scheme to light, Amanda Cashi, the whistleblower, will receive 20% of the award or $250,000. None of the hospitals that overcharged Medicare were charged since they had relied on EV3’s bad advice.
Medicare fraud costs taxpayers billions of dollars annually. Many of these scams only come to light through the efforts of whistleblowers, brave men and women who stand up to fraud and corruption. Under the federal False Claims Act, whistleblowers can receive up to 30% of whatever the government collects from the wrongdoers.
To become eligible for a whistleblower award under the False Claims Act, one must have original source (inside) information about a fraud involving a government funded program.
Have information about Medicare fraud? Visit our healthcare fraud whistleblower page.
Ready to see if you qualify for an award? Give us call today. We help whistleblowers stop fraud and collect the maximum awards possible. Federal and state whistleblower programs are available for other frauds such as unpaid taxes, securities violations, government contract fraud, certain environmental violations and residential mortgage fraud.