Trillions of dollars are paid out every year through government programs. With this much money passing hands, it can be difficult to track where all this money goes, which can provide the opportunity for fraud. Laws like the False Claims Act ("FCA") and the Whistleblower Protection Act ("WPA") were implemented to help protect the government and prevent and prosecute fraud. The FCA enables the government to prosecute individuals or organizations that have committed fraud, and the WPA protects employees from retaliation for uncovering and disclosing illegal behavior within an organization. The WPA also provides substantial compensation for those willing to bring forth evidence of fraud.
IPC Healthcare Inc. ("IPC") is a health care provider owned by TeamHealth Holdings. Under the protection of the WPA, a former physician, Dr. Bijan Oughatiyan ("Oughatiyan"), alleged IPC violated the FCA by illegally incentivizing its physicians to overcharge Medicare and Medicaid patients. Physicians were given bonuses for meeting revenue quotas and were penalized for failing to achieve them. Accordingly, this practice encouraged physicians to file for payment from the government for procedures that were more expensive than the ones actually performed. Although patients did not incur any additional charges, the extra financial burden was placed on the government, which resulted in the government paying out millions of taxpayer dollars for procedures that did not take place.
Oughatiyan produced incriminating evidence that showed physicians were charging for procedures that were not preformed. The suit was settled with the agreement that TeamHealth Holdings pay $60 million plus interest, along with entering into a five-year contract that enhances the organization's transparency; however, it was not obligated to admit wrongdoing. As the whistleblower, Oughatiyan will likely receive an amount close to $11.4 million for his role in the lawsuit.
The legal team at SFMS has significant experience litigating whistleblower matters. If you have any questions regarding this subject or this posting, please contact Nick Lussier (firstname.lastname@example.org) or Chiharu Sekino (email@example.com). We can also be reached toll-free at (866) 540-5505.
Shepherd, Finkelman, Miller & Shah, LLP is a law firm with offices in California, Connecticut, Florida, New Jersey, New York, and Pennsylvania. SFMS is an active member of Integrated Advisory Group (www.iaginternational.org), which provides us with the ability to provide our clients with access to excellent legal and accounting resources throughout the globe. For more information about our firm, please visit us at www.sfmslaw.com.
Jones, Diana Novak. "Health Care Co. To Pay $60M To End Whistleblower Fraud Suit," Law360. Last modified February 6, 2017.
"Federal Spending: Where does the money go," National Priorities Project.