Valley Tumor Medical Group Settles Major Whistleblower Lawsuit for $3 Million Dollars for False Billing of Medicare, Medi-Cal and TRICARE

Our Los Angeles False Claims Act and Whistleblower law attorneys report another major multi-million dollar settlement against a health care provider.  This time it is against a California based oncology center.  The allegations were brought by a former center technician who claimed that the oncology center submitted fraudulent bills to Medicare, Medi-Cal and TRICARE over a 10 year period without the required presence of a physician.  The settlement includes payments to the federal government and California state government.

The oncology center provided radiation therapy to many elderly, poor and military veterans.  As part of the requirement to submit payment claims for those beneficiaries under those programs, the oncology center needed to have a physician present and immediately available.  Instead, the center chose to ignore those requirements and submitted almost 50,000 radiation procedures for payment which were conducted by unsupervised technicians allegedly causing more than $7 million dollars in damage to the government.  The whistleblower technician will receive over a half million dollars for his brave False Claims Act (“FCA”) complaint.

Under the FCA, the Judge is entitled 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 will receive approximately 15 to 25 percent of the total FCA recovery plus attorney’s fees. 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 prosecute or allow the whistleblower to bring the complaint on the government’s behalf.

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.