Our New York Whistleblower Attorney has been asked to comment on a recent Medicare fraud case that was brought under the False Claims Act. It is important to stop government fraud including Medicare Fraud because it affects society as a whole. It is has been reported that Medicare Fraud is estimated to be 50 billion dollars annually. If you are aware of any situations where the government is being defrauded, contact our office for a confidential consultation. As discussed below, it is important for whistleblowers to speak with counsel before taking any steps.
Moore Case Background and General Considerations
Dr. Jean Moore, a physician, blew the whistle by filing a lawsuit under the False Claims Act against Mercy Health Springfield Communities, formerly known as St. John’s Health System Inc., which owns and operates a hospital in Springfield, Missouri, and its affiliate, Mercy Clinic Springfield Communities, formerly known as St. John’s Clinic. It was alleged that the defendants submitted false claims to the Medicare Program for services rendered and the referring physicians received improper bonuses. There are strict laws that regulate whether bonuses can be paid to referring patients for policy and health reasons. Patient care and medical treatment should be paramount. Indeed, according to press reports, U.S. Attorney Tammy Dickinson stated “[a] bonus structure that rewards physicians based on the value of their referrals is detrimental to both the quality and the cost of health care. Patients deserve assurances that they are receiving appropriate medical care, unbiased by hidden incentives. And taxpayers deserve assurances that the cost of public health care programs is not inflated by unnecessary procedures and services.”
The Principal Deputy Assistant Attorney General Benjamin Mizer further stated, according to press reports, that “[w]hen physicians are rewarded financially for referring patients to hospitals or other health care providers, it can affect their medical judgment, resulting in overutilization of services that drives up health care costs for everyone. In addition to yielding a recovery for taxpayers, this settlement should deter similar conduct in the future and help make health care more affordable.”
Sometimes improper referral bonuses are categorized as incentive payments. If you are aware of any improper activities in the medical field, you should consult legal counsel at the outset. Our attorneys have represented many employees in the healthcare industry including physicians, nurses, hospital management and pharmaceutical employees. There can be significant monetary rewards for whistleblowers. In fact, Dr. Moore is reportedly expected to receive over $800,000 as part of the government’s recovery. While the potential rewards may rush you to take action, here are a few considerations and questions to keep in mind:
- Did you participate in the improper activity in any way? This can be a tricky area for whistleblowers and early counsel for your specific situation is critical.
- Has anyone else already complained about the alleged improper activity? One of the hallmarks of being a whistleblower is being the first to report the alleged wrongdoing. If the government is already aware of the allegations or it is otherwise investigating them (or the allegations have been covered in the media), you may not qualify as a whistleblower.
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