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Whistleblower could score big in health care false billing case

We stressed a few fundamental points regarding qui tam whistleblower lawsuits that individuals file on behalf of the federal government under the U.S. False Claims Act in a recent post. We noted in our January 31 entry that such filings seem to be spiking these days. Moreover, "they feature in stories involving federal agencies and entities of virtually every type and dimension."

Like the Centers for Medicare and Medicaid Services, for instance. The CMM is tasked with dealing with the legions of health providers in Connecticut and across the country who treat and bill patients receiving treatment under federal health programs.

That is a major effort, and it is complicated by the CMM's necessary focus on a select group of providers that attempt to cheat the government and taxpayers through fraudulent acts, including false billings.

Medical care fraud is truly big business and a phenomenon that has spotlighted whistleblowers and their role in uncovering wrongdoing and helping to stop it.

A recent case from Delaware underscores just how important that role can be. In that matter, a diagnostic testing company was using a procedure during MRI administration without direct oversight from a physician, which was required. The company did that thousands of times absent the required input and with full knowledge of the illegality. The false billings it sent to Medicare for reimbursement greatly inflated the legitimate costs of the procedure.

A facility worker noting the disconnect internally questioned it and subsequently came forward as a whistleblower, filing a lawsuit alleging fraud against the government.

That suit recently concluded after federal officials intervened in the matter. A federal court granted the government a default judgment against the company and its owner.

The result: a $16 million fine assessed against the defendants, with 18% of the judgment amount -- close to $3 million -- going to the ex-employee for the vitally important work that individual did as a whistleblower calling out and helping to eradicate fraud.

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