21st Oncology Inc., a national health care company managing 145 cancer clinics in 16 states, entered into an agreement this week to pay $35 million dollars to settle a False Claims Act (FCA) case. The FCA violations centered on alleged fraudulent billing of Medicare for radiation treatments. This type of illegible billing of Medicare is just another example in a long string of similar cases this year. See these other blogs for similar cases covered by our Los Angeles based Employment Lawyers. The Whistleblower here was a former physician for the company who witnessed the pushing of untested doses of radiation treatment onto the patients without first ensuring that the physicians were properly trained. This resulted in the treatment outcomes not serving any purpose for the health care providers and a waste of millions of taxpayer dollars. Most likely, the company was trying to recoup its costs for buying the expensive new technologies by pushing the products onto its providers, and indirectly billing Medicare for services that proved no benefit to the patients.
Most often, the FCA is used within the health care industry to stem out fraud related to billing, staffing, and kickbacks. Examples of these are when a provider of health care services such as a doctor or hospital bills for services that were not provided or the bill was submitted at an improperly higher rate of reimbursement for the services. In addition, health care companies are often fount 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.