Three Whistleblowers Awarded Payments Through the False Claim Act for Disclosing Medicare Fraud

WBOC reported on November 8, 2109, that one of the New York’s largest healthcare providers, Northwell Health, Inc. (which includes Lenox Hill Hospital) agreed to pay $12.3 million to settle claims it submitted false bills to Medicare. The settlement was based on a lawsuit brought by three whistleblowers.

The claims involved three different schemes that involved one of the hospital’s urologists, David B. Samadi:

  1. That the hospital overpaid the urologist – to obtain referrals to the hospital – in violation of the Stark Act. The Stark Act is an anti-self-referral law. It forbids doctors from referring patients to “designated health services” where the doctor (or an immediate family member) has a financial interest and the services are paid by Medicare or Medicaid. No Stark Law exceptions applied in this case.
  2. Northwell billed Medicare “for surgeries where Samadi violated billing procedures governing overlapping surgeries.“
  3. Northwell billed Medicare for operating room procedures that weren’t medically necessary.

The settlement of the Medicare fraud charges stated that Dr. Samadi was not present in one operating room when an endoscopy surgery overlapped with another endoscopy surgery – “throughout the entire period of time the scope was inserted to the time the scope was removed.” The False Claims Act agreement also confirmed that the doctor would “freeze or pause the robotic equipment in OR 25 and leave the patient under the care of the anesthesiologist, operating room staff, and, in some instances, a urology resident.”

The settlement acknowledged that the defendant’s conduct resulted in inappropriate claims, for millions of dollars, being submitted to Medicare.

Whistleblowers/relators are entitled to a percentage of any recovery (between 15 and 30%) when there is a settlement or verdict in a False Claims Act case. There are strict requirements for filing a False Claims Act disclosure which an experienced whistleblower lawyer can explain and pursue.

The False Claims Act attorneys at the Law office of Stephan Danz have the experience and resources to help you get justice. Call us at 877-789-9707 to or contact us online to schedule an appointment.