The Employment Law Group® law firm is experienced in representing employees who blow the whistle on fraudulent testing practices. Our attorneys have represented doctors, nurses, Medicare billing specialists, accountants, administrators, testing marketers, and other employees in their whistleblower claims. We have testing fraud cases currently in progress.
In September 2019, TELG client Kevin Manieri — an experienced sales professional — was awarded more than $12 million for reporting that a drug company defrauded Medicare and other government insurance programs by encouraging doctors to prescribe an unnecessary medication to patients. In March 2016, our client Joseph Ting was awarded more than $7 million for revealing overbilling and unnecessary testing by 21st Century Oncology, a large cancer-treatment company.
The U.S. government awarded a TELG client 20% of its settlement with a sleep-disorder facility that pretended to diagnose sleep problems. And two TELG clients helped the government reach a $2.8 million settlement with clinics accused of billing Medicare for physical therapy performed by unqualified staff members.
The False Claims Act makes it illegal to bill the U.S. government for — as an example — medically unnecessary respiratory panels or pulmonary tests, or to pay kickbacks or otherwise wrongfully induce pharmacies to dispense certain COVID-19 medications. The law provides a financial incentive for whistleblowers to report such wrongdoing by filing a lawsuit on behalf of taxpayers. This "qui tam" provision allows prevailing plaintiffs to receive up to 30% of the money returned to the U.S. Treasury.
If a whistleblower gets fired for reporting fraud, or suffers other retaliation, the FCA requires that the harm be reversed entirely: Successful plaintiffs may get their jobs back — and may receive damages including attorney fees and payment for emotional distress.
As with all legal claims, deadlines are crucial. If you have been punished for drawing attention to shady behavior by a hospital, medical professional, or pharmaceutical company, you must file a retaliation claim under the FCA within three years. The statute of limitations for the underlying fraud generally is six years under the FCA — or 10 years in a few situations. Other laws, including some relevant state laws, may demand faster action.
Frequently Asked Questions
How are coronavirus whistleblowers rewarded?
As an inducement for people to expose fraud against programs such as Medicare, the False Claims Act allows whistleblowers to receive up to 30% of any money the U.S. government recovers as a result of their litigation. Because a large percentage of COVID-19-related testing is funded by federal government — and because the government faces a wave of coronavirus profiteers — the FCA is a powerful incentive for whistleblowers who know of COVID-19 testing fraud. Depending on your state, other rewards statutes also may apply.
How does COVID-19 testing fraud typically work?
Medicare and TRICARE are government health insurance programs for older people and military members and their families, respectively. They include a benefit for COVID-19 tests as indicated in the current pandemic. Related tests also are allowed as long as they are prescribed by a doctor; are medically needed; are billed accurately; and are not induced through illegal means such as kickbacks.
If you work for a hospital, medical professional, lab, or pharmacy, you may have seen evidence of the following illegal practices:
- Medically unnecessary tests: Regular COVID-19 tests sometimes are combined with a much more expensive test that does not address COVID-19, such as a respiratory pathogen panel (RPP), in order to boost profit.
- Kickbacks: Some hospitals, labs, pharmacies, or other facilities may offer money, gifts, or other favors to doctors who refer lucrative patients.
- Billing fraud: Testing facilities, hospitals, or pharmacies may bill for tests they did not deliver — or for what the FBI describes as fake … treatments, including hydroxychloroquine combinations that may be ineffective or inappropriate.
How do I report coronavirus testing fraud?
COVID-19 fraud against Medicare can be reported via StopMedicareFraud.gov, a joint Web site of the Department of Justice and the Department of Health and Human Services.
If you know of major COVID-testing fraud, however — or if you face retaliation in connection with such fraud — you may want to file a whistleblower lawsuit under the False Claims Act, a state equivalent, or both. Such a step isn’t trivial. If you would like to have an experienced law firm on your side, please contact us.