Norman Regional Health System Settles Medicare Whistleblowing Case Totaling $1.6 Million

Our Los Angeles and Orange County False Claims Act (“FCA”) attorneys reported another remarkable settlement in the health care industry.  This time it was Norman Regional Health System and the settlement was just announced with the U.S. Attorneys’ Office in a false billing of radiology services case.

In this case, the health system was alleged to have been billing Medicare for radiology assistants performing services when they were not under the direct supervision of a radiologist as required by Medicare.  According to the health system, the settlement was entered into to resolve the allegations so that they can move on rather than admitting fault.  That is the typical lingo by unscrupulous corporations who are caught red-handed.  The total settlement amount is a refund to the federal government for the amount Medicare paid for the services, plus penalties.

Under FCA, the court is allowed to order the defendant to pay triple the actual damages that the jury finds.  In addition, the FCA also permits statutory penalties from $5,500 to $11,000 for each false claim submitted by the defendant.  As result, the whistleblower here may receive approximately 15 to 25 percent of the total FCA recovery plus attorney’s fees.  Here, that may add up to around $250,000.  This is a just reward for someone who stems out health care fraud.

As the main enforcement arm of the federal government, the Justice Department reviews all cases filed under the FCA.   Then, once the whistleblower case is assessed, the government decides whether it will step in and prosecute or step back and allow the whistleblower to bring the complaint on the government’s behalf.  Here, the Department of Justice decided not to step in and intervene.

The FCA is used to stem out fraud related to billing, staffing, and kickbacks. Examples of these are when financial companies are supposed to abide by state and federal laws and chose to ignore them.  They also bills for services that were not provided or the bill was submitted at an improperly higher rate of reimbursement for the services.  In addition, financial companies are often fount to illegally bill the government for substandard services by fraudulently certifying otherwise. Alternatively, these companies may realize that they have credit from their services that they have to repay to the government, but the companies do not reimburse the government within the 60 day time frame.  See these blogs for more examples of the FCA.

If you witness any potential false claims in California (i.e. requests for reimbursement to the government, not actually rendering work when reimbursement is received, or receiving and knowingly retaining an overpayment) by your company, or you are retaliated against for voicing your concern about potential wrongdoing, immediate action is vital.  Contact the experienced employment law attorneys at Stephen Danz & Associates for a free consultation to discuss your circumstances and legal options.