$300,000 Whistleblower Settlement Added to U.S. Department of Justice’s $2.9 Billion in 2016

Another week brings with it a number of newly revealed Whistleblower Qui Tam lawsuit settlements.  This time, it is a dental company settling with the government for more than $300,000 over false Medicaid billing.   As the corporate practice of dentistry expands across California and the rest of the nation so too are instances of fraudulent conduct.  This fraud is not limited to the federal Medicare and state Medicaid governments as it also includes defrauding of commercial insurance and private pay.  Our firm has represented other plaintiffs in lawsuits against dental corporations as they are teeming with unlawful conduct and dishonest behavior. In this instance, a dental company by the name of Lifepoint dental Group, LLC was caught by the U.S. government when two of its employees brought whistleblower, or qui tam, lawsuits against it several months apart.

The lawsuit alleged claims under the False Claims Act’s whistleblower provision as they pertain to the protection of the Medicaid government program.  At the crux of the complaint, we saw retaliation for the whistleblower’s complaints, wrongful termination, and fraudulent Medicaid overbilling.  When one of the whistleblowers complained to the CEO about illegitimate charges, he was terminated.  Shortly thereafter, when a second whistleblower complained about similar fraudulent practices, she was also fired.  Out of the $300,000 settlement, each of the whistleblowers will receive $45,209, or 15 percent of the total recovered amount because the government intervened.  See these other blogs for examples of much higher whistleblower payments.

Health care companies are often found to illegally bill the government for substandard services by fraudulently using higher diagnostic codes or by falsely certifying the medical necessity of medical procedures. 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.  At that point, the nonpayment becomes a false claim. To combat retribution for filing FCA claims, the Health and Safety Code Section 1278.5 prohibits retaliation against patients, physicians, nurses and medical staff who whistleblow to the government or its agencies on patient care issues at a health care facility.  Even the IRS has been getting in on the action and recently reported that in Fiscal Year 2015 it paid out more than $103 million to whistleblowers resulting from settlements in successful lawsuits.

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 crucial.  Contact the experienced employment law attorneys at Stephen Danz & Associates for a free consultation to discuss your circumstances and legal options.