Perhaps you are a new employee working in the billing department of a busy medical office. You are beginning to note some discrepancies between the services provided and the services billed. Are these simple errors, or are employees defrauding the government?
In 2017, whistleblowers in the U.S. helped the United States government reclaim as much as $3.4 billion in misappropriated or stolen funds. The government rewarded them in a big way. The informants earned more than $392 million for their efforts in reporting fraudulent activities.
A co-owner of a Minnesota dermatology practice filed a False Claims Act suit stating the dermatologist, Dr. Ebertz, routinely overbilled Medicare for procedures that were not necessary. The doctor would treat a benign lesion but bill it as a more expensive pre-cancerous condition. After speaking out about the ongoing fraud, the whistleblower, Dr. Jeff Samuelson, was asked to leave the practice. He moved to California, where he now works. The Minnesota practice resolved the charges of false surgeries and fraudulent Medicare billings by paying the government $850,000.
Keeping illegal activities going
AmerisourceBergen Corporation, a wholesale medical company, had been unlawfully repackaging and reselling drugs and creating fake patients for at least 13 years. The company created a fraudulent scheme to sell drugs in prefilled syringes and realized a profit of about $100 million. Three whistleblowers uncovered the scheme and filed lawsuits under the False Claims Act. As a result, the company settled with the government for $625 million.
The many faces of fraud
Defrauding government agencies like Medicare takes many forms, including:
- Charging the government an inflated price
- Failing to report adverse events in the company
- Fraudulent representation involving a government contract
- Kickbacks in healthcare contracts
- Misuse of grant funds
If you have knowledge of an effort to defraud the government, you may want to find out about the legal options available. Remember that the False Claims Act and other laws protect all whistleblowers so they can stand up for what is right without fear of retaliation.