A South Florida resident will receive $200,000 this week after turning her boss in for Medicare fraud. Lori Moore worked for years at the Clear Vue Eye Center. After awhile she began to realize that something was amiss. The owner of the clinic, Dr. Monique Barbour was living an extremely lavish lifestyle yet the patients coming into the clinic just didn’t support her income.
As Moore began to question billings, she was fired. Instead of doing nothing, Moore became a whistleblower and filed a complaint under the False Claims Act. This week Dr. Barbour agreed to pay $1 million in penalties and Moore learned she would be receiving a $200,000 whistleblower award.
According to Moore’s complaint, Dr. Barbour engaged in almost every type of Medicare and Medicaid fraud possible. For example, Dr. Barbour:
- altered the dates that procedures were performed to increase the amount charged for the
- maintained improper cost reports;
- billed for more expensive procedures than necessary (upcoding)
- billed for serviees not rendered;
- submitted false information to Medicare: and
- violated the federal Anti Kickback Statute by providing checks, cash, and checks to physicians in exchange for referrals.
Billing for services not delivered and submitting false information are obvious but some of the other allegations are more difficult to detect absent an insider.
Unbundling occurs when a healthcare provider performs multiple services on the same day but changes the dates of service to make it appear that the patient required more than one office visit. For a typical laser eye treatment, a physician can receive $240.63 if both eyes are treated on the same day. If two visits are required, however, the physician receives $347. Dr. Barbour was performing both services during the same visit but billing for separate visits.
Upcoding occurs when a physician bills for a more expensive treatment than is medically necessary. For example, a routine eye exam may take 15 minutes and should be billed as such. Moore said that Barbour would frequently bill as if an extended 45 minute consultation took place even though the visit was completely routine. Prosecutors say that some of her bills suggested she worked 20 hours a day even though her patient records showed otherwise.
Unbundling and upcoding don’t usually endanger patient safety, although the practices are highly illegal. These fraud are essentially stealing. Sometimes, however, Barbour sent unlicensed optometrists or technicians to see patients. Using an unlicensed person may be legal in certain cases if properly supervised by a licensed doctor but Moore says Dr. Barbour was often not around meaning people that were both unlicensed and unsupervised were seeing patients. Sometimes Barbour wasn’t even in the country. Worse, sometimes the technician would bill for services even though she didn’t even see any patients.
And where did all the money go? Moore says that Barbour was spending the money on lavish trips, multiple homes and even to help her career as an aspiring pop star, Anayya Von Kitten.
Moore Suffers Whistleblower Retaliation
Like many whistleblowers, Lori Moore wasn’t happy with what she observed. Things came to a head, however, when Barbour asked Moore to falsify records. Moore says she complained and was fired shortly thereafter. Moore was let go in February of 2014. Six months later she filed her whistleblower complaint under the False Claims Act.
False Claims Act and Whistleblower Awards
The federal False Claims Act allows people with inside information about fraud involving tax dollars to file a complaint in federal court. If the government ultimately recovers money from the wrongdoers, the whistleblower can receive between 15% and 30% of the recovery. In this case, the government is collecting $1 million and Lori Moore is to receive 20% or $200,o00.
In announcing the settlement, a Health and Human Services spokesperson said, “It is hard to imagine how a single practitioner believed billing for more hours than were possible to perform in a day would not alert law enforcement to a potentially fraudulent scheme. Billing for work supposedly performed while you were physically in another country is a special kind of arrogance and disregard for the ethical care of patients.”
Medicare is funded with federal taxes meaning Medicare fraud is eligible for whistleblower awards. 29 states have similar False Claims Act type laws that cover state funded Medicaid. (Florida is one of those states).
The False Claims Act also has powerful anti-retaliation remedies that make Moore eligible for even more money.
MahanyLaw – False Claims Act Whistleblower Lawyers
The lawyers at MahanyLaw have helped their clients recover over $100 million in whistleblower awards just during the last five years. If you are thinking about blowing the whistle on your employer, give us a call. We can help you determine if you have a good case, investigate the claims, file the lawsuit and even prosecute the case if the government fails to do so. We can also protect you from retaliation.
Need more information? Our consultations are confidential and without cost or obligation. If you hire us, you don’t owe us any money unless we recover money for you.
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