- In February, a physician’s practice in Florida agreed to settle a FCA claim based on Medicare fraud for $750,000. The qui tam suit against Dr. Paul B. Tartell was filed by a former patient Theodore Duay. Duay alleged that Tartell would bill Medicare and the Federal Employee Health Benefits Program for procedures that were not medically necessary or not performed at all. Numerous federal agencies were involved in negotiating this settlement, and Duay will receive $135,000 for filing the action.
- TeamHealth Holdings will pay $60 million plus interest due to allegations its business, IPC Healthcare Inc., committed fraud against Medicare, Medicaid, the Defense Health Agency, and the Federal Employees Health Benefits Program by billing for more expensive medical services than what were actually provided. Dr. Bijan Oughatiyan filed a qui tam action under the FCA alleging the practice of “upcoding.” The federal government investigated and chose to intervene, providing a detailed description of how IPC Healthcare used false codes to receive greater reimbursements. Oughatiyan will receive $11.4 million for his participation.
- The Fourth Circuit determined in the FCA case of U.S. ex rel. Michaels v. Agape Senior Community, Inc., that the government has the unreviewable right to veto a settlement between the individual who filed a qui tam action, known as the relator, and the defendants. During this suit, the relator alleged that a group of senior-care facilities, Agape, committed fraud against Medicare. After the federal government declined to intervene, the relator and Agape held negotiations and agreement upon a proposed settlement. On behalf of the government, the attorney general objected to the settlement because it was far less than the estimated value of the fraud. The Fourth Circuit’s decision, which agrees with the Fifth and Sixth Circuits, only furthers a disagreement between the circuit courts. The Ninth Circuit has previously stated that an attorney general’s objection to a settlement can be reviewed by the district court for reasonableness.
- U.S. ex rel. Michaels v. Agape Senior Community, Inc. is important for a second reason. The Fourth Circuit declined to answer the question of whether statistical sampling can be used in FCA cases. Many relators attempt to use statistical sampling to prove damages under the FCA instead of proving every single fraudulent claim and the damage it caused, which can be burdensome in many cases. The district court determined that statistical sampling is only appropriate when the evidence is dissipated, making direct proof of damages impossible. The Fourth Circuit declined to look at the issue stating it was not a pure question of law.
Do You Have Information About Fraud Against the Government?
If you believe you have evidence that a person or business is committing fraud against the federal government, you may be able to file a qui tam action. Contact an experienced California qui tam lawyer of Brod Law Firm at (800) 427-7020.
(image courtesy of M. Connors)