Jose Diaz, Lisandra Aguilera, and Estrella Rodriguez were all once employed by Metro Med of Hialeah Corp. The Metro Med clinic was allegedly a facility that helped HIV positive patients receive medically necessary infusions and injections. Many of these patients were Medicare beneficiaries. According to prosecutors, the fraudulent clinic charged for infusion therapies which were medically unnecessary or not provided at all.

In the operation of their fraudulent Medicare scheme, the group would provide kickbacks to patients who allowed them to use their Medicare number to fraudulently bill the system. In some instances the workers would falsify the blood test results, making it appear as if certain injections and infusions were medically necessary.

The scheme began in April of 2003, not long after the Metro Med clinic opened. The group continued its practice of Medicare fraud all the way up until October of 2005. Although they billed Medicare for an estimated $23 million, the group received only about $11.7 million in Medicare payments.

Diaz has been sentenced to 54 months in prison, while Aguilera received 70 months and Rodriguez received 57 months. Damaris Oliva, former owner of Metro Med, was previously sentenced to 82 months in prison for her role in the scheme. Dr. De Los Rios has been convicted of the conspiracy charges against him, and will be sentenced on June 27th for crimes.

If you are considering bringing a qui tam against a former employer, contact a Florida attorney to evaluate the strength of the complaint and protect your rights in the claim.

ATC operated partial hospitalization programs (PHPs) in seven different locations throughout Florida. A PHP is a form of intensive treatment for severe mental illness. Medlink operated as a  "management company” for health care businesses. In reality, ATC and a related company, the American Sleep Institute (ASI), were Medlink’s only clients.

ATC and Medlink are each charged with conspiracy to commit health care fraud in a superseding indictment unsealed on Feb. 15, 2011. ATC is also charged with health care fraud and conspiracy to defraud the United States and to pay and receive illegal health care kickbacks.

U.S. Attorney Wifredo Ferrer for the Southern District of Florida, stated the following:

The defendants altered patient files, diagnoses and medication types and levels to make it appear that patients being treated qualified for PHP treatments. This was done so that the defendants could fraudulently bill Medicare for more than $200 million in medically unnecessary services. We are pleased to have put these unscrupulous operators out of business.”

Special Agent in Charge John V. Gillies of the FBI’s Miami Field Office was on target when he stated the following:

“No matter what the scheme or how elaborately it was disguised, personal and corporate greed by these two corporations and their owners defrauded taxpayers of millions of dollars. Ultimately, health care fraud robs from the elderly and disabled.

As indicated in this case, fraud is usually not accomplished alone. It takes one to mastermind and several players to make it work. This is how a whistleblower comes across information that his company is engaging in fraudulent practices.

Since March 2007, thanks to the valiant efforts of the Medicare Fraud Strike Force, over 1,000 defendants who collectively have billed the Medicare program for more than $2.3 billion, have been prosecuted on fraud charges.This could not have been done without the combined efforts of whistleblowers and the Health Care Fraud Prevention and Enforcement Action Team (HEAT).

Under the False Claims Act. whistleblowers have an added incentive to report fraud. This Act allows whistleblowers to receive a reward of 15-25% if the government intervenes in the lawsuit. If the government chooses not to proceed, the whistleblower can pursue the case on behalf of the government alone and will be entitled to 25-30% of the governments proceeds in qui tam or false claims cases.

If you are considering bringing a Florida lawyers against a former employer, contact a qui tam attorney to evaluate the strength of the complaint and protect your rights.

Click on the following link to read more on the following links:

Two Miami-Area Corporations Plead Guilty to More Than $200 Million Medicare Fraud - FBI

Couple pleads guilty to Medicare Fraud - Sun Sentinel

Understanding Qui tam and How the False Claims Act works - Whistleblower Law Blog

The U.S. Justice Department recently announced that a $3 million settlement had been reached in the case of a Florida radiology clinic that violated the Medicare False Claims Act.

The case was filed in 2009 after two physicians employed by the radiology clinic effectively blew the whistle on the violations and each became a relator in a qui tam suit.

Each relator claimed that the violations to the Medicare False Claims Act occurred during the period between 2000 and 2008. Essentially, the physicians alleged that Midtown Imaging, LLC and the former owners of the clinic, listed as Midtown Imaging, P.A. and PBC Medical Imaging, embarked upon improper financial relationships with other physicians and physicians groups.

Wifredo Ferrer, U.S. Attorney for the Southern District of Florida hailed this latest ruling as a great success for the False Claims Act. He acknowledges the scarcity of Medicare funds and also recognizes how heavily some Americans must rely on Medicare to cover the basic costs of their health care. To that end, Ferrer reiterated the U.S. government’s commitment to fight fraud against the Medicare system and asks that any potential whistleblowers come forward with evidence of abuse or fraud.

It is through the actions of brave whistleblowers such as the former employees of Midtown Imaging, LLC that qui tam actions are prosecuted and successfully tried. We need more brave people to stand up against corruption and fraud.

Whistleblowers have the satisfaction of doing the right thing when bringing suit under the False Claims Act. As an incentive, the False Claims Act allows for a reward of 15-25% for the relator if the government intervenes in the lawsuit. If the government resists involvement, the plaintiff may decide to pursue the case alone and will be entitled to 25-30% of the award. In the Midtown Imaging case, each relator is now entitled to $600,000.

If you are considering bringing a qui tam or whistleblower suit against a former employer, contact a qui tam attorney to evaluate the strength of the complaint and protect your rights.

Betancourt must pay approximately $6 million in restitution for his crimes against Medicare. As a rehabilitation center employee, Betancourt is said to have paid patients to sign fraudulent paperwork stating that they had received injections and other treatments that they did not actually receive. After receiving payment from Medicare, Betancourt laundered the money through phony corporations created for this express purpose.

After being captured in Miami and agreeing to a trial there instead of Michigan, Betancourt was charged with conspiracy to commit health care fraud and conspiracy to commit money laundering. He eventually plead guilty to the charges and was sentenced by U.S. District Court Judge Cecilia Altonaga in the Southern District of Florida on June 7, 2011.

Betancourt admitted that the scheme occurred throughout 2006 and 2007. This is not the first case of Medicare fraud that has been successfully prosecuted in the United States since the Medicare Fraud Strike Force was founded in March of 2007. The strike force was created specifically to combat crimes such as those committed by Betancourt and the Guilarte sisters.

To date the strike force has charged in excess of 1,000 defendants for fraudulently billing Medicare. Combined, the 1,000 defendants have defrauded the Medicare program of some $2.3 billion. As the strike force garners continued success, it seems likely that Medicare will be losing less of its funds to fraud.

Click on the following link to read more on:

Patient Recruiter Sentenced to 77 Months in Prison in Connection with $9 Million Medicare Fraud Scam in Detroit

Under the Serno agreement, proceeds from the settlement will be split between the federal government and various states, with the United States receiving $34.6 million to resolve the federal claims and the states receiving $9.7 million to settle their respective claims under Medicaid.

As a Florida False Claims Act and Whistleblower Law Firm, we applaud the whistleblower, Tim Amato, who brought the qui tam suit in 2005. The False Claims Act permits private citizens with knowledge of fraud against the government to bring a lawsuit on behalf of the United States and to share in any recovery.  Mr Amato will receive $5.19 million out of the federal share of the Serno civil settlement.

Allegedly, health care providers were paid from the launch of Rebif in January 2002 through December 2009, to promote or prescribe Rebif, a recombinant interferon that is used to treat relapsing forms of multiple sclerosis. The payments were made to providers for hundreds of speaker training meetings and programs, as well as payments for attending consultant, marketing and advisory board meetings, all at upscale resorts and other locations. Serono’s actions allegedly resulted in the submission of false claims to federal health care programs including Medicare and Medicaid for the payment of Rebif, i.e., claims that were tainted by kickbacks.

It is a great day in America when the government can combat corporate greed and health care fraud. The False Claims Act is a powerful tool in that effort and allows the government to recover triple the amount of its actual damages, plus a civil penalty of $5,500 to $11,000 for each false claim.

We encourage whistleblowers to come forward and report fraud against the government. If you are aware of corporate fraud against the federal or state government, contact a whistleblower or qui tam lawyer to discuss your legal rights and steps to take on reporting the fraud.

Click on the following links to read more on the $44.3M Serno FCA Settlement:

Pharmaceutical Giant, Serono, Agrees to Pay $44.3 Million to Settle False Claims Act Case - DOJ

Serono to Pay $44.3 Million to Resolve False Claims Act Allegations in Connection With Promotion of Drug Rebif - PharmaLive

The Strike Force has operations in nine districts and has charged 1,000 defendants who collectively have falsely billed the Medicare program for more than $2.3 billion. The government is taking a stand to thwart unscrupulous providers from bilking the system with fraudulent claims. Thanks to valiant whistleblowers coming forward, more Medicare fraud is being reported.

Whistleblowers should seek an experienced qui tam attorney to discuss their potential whistleblower claim. As mentioned previously on the whistleblower law blog, a successful qui tam outcomes can result in substantial settlements or judgments. A whistleblower may be entitled to a whistleblower reward reward of 15-25% due to provisions in the False Claims Act. 

If the government does not intervene in the case, the whistleblower can pursue the case, and may be entitled to a whistleblower reward of 25-30%.  A qui tam attorney can evaluate the strength of the complaint and protect the privacy, rights and interests of those clients with a legitimate whistleblower claim.

Whistleblowers should seek an experienced qui tam attorney to discuss their potential whistleblower claim. As mentioned previously on the whistleblower law blog, a successful qui tam outcomes can result in substantial settlements or judgments. A whistleblower may be entitled to a whistleblower reward reward of 15-25% due to provisions in the False Claims Act. 

If the government does not intervene in the case, the whistleblower can pursue the case, and may be entitled to a whistleblower reward of 25-30%.  A qui tam attorney can evaluate the strength of the complaint and protect the privacy, rights and interests of those clients with a legitimate whistleblower claim.

Who's Defrauding Medicare?

The 111 individuals charged consisted mostly of doctors, nurses, and health care company owners / executives. The fraud consisted of over $225 million in false billing.

Attorney General Eric Holder stated that the arrests prove that the Department of Justice is “waging an aggressive fight against health care fraud” and securing taxpayer dollars. In 2010 alone, Holder went on to say, the Medicare Fraud Strike Force recovered more than $4 billion in fraudulent Medicare claims. The Strike Force focuses primarily on identifying and shutting down large-scale fraud schemes.

Examples of Fraud

The arrests on February 17 included some of the following examples:

Miami 32 defendants, including 10 health care professionals, participated in frauds that led to $55 million in false billings. The false billings were mostly for home health care, medical equipment, and prescription drugs.
 

• Detroit:21 defendants, including 9 health care professionals, defrauded Medicare for $23 million. These cases included home health care, psychotherapy, physical therapy, and podiatry.
• Brooklyn: A mere 10 people, including 4 health care professionals, managed to run schemes that totaled $90 million. These schemes focused on physical therapy, proctology, and nerve conduction testing.
• Los Angeles: 5 individuals defrauded Medicare for $28 million, mostly with false claims for medical equipment and home health care.

The strike force intends to expand its operations into Dallas and Chicago – the next two cities that have been identified as fraud hot spots.

Medical Identity Theft

The Office of the Inspector General (OIG) calls attention to a new sort of identity theft – medical identity theft. This identity theft relies upon a person's name, Social Security number, or Medicare number to make false prescription drug claims and other false Medicare claims. Like other types of identity theft, medical identity theft can threaten the victim's credit and finances, while simultaneously defrauding taxpayers.

As basic precautions against healthcare fraud, OIG suggests the following measures:

• Protect your information by not giving out your Medicare number to people who offer free medical equipment or services, or who offer a free gift in exchange for a Medicare number.
• Check your Medicare Summary Notices to see if you were billed twice for anything or if you were charged for any services or equipment that you didn't receive.
•  If you do suspect someone is using your Medicare or Social Security number to commit fraud, contact the Department of Health and Human Services

Considering the ongoing, heated debates over health care in America, watching out for medical identity theft is one step Medicare recipients can take to ensure all taxpayers are protected from healthcare fraud.
 

Recently, the Senate Committee on Health & Long Term Care met to discuss SB 5458. Several groups raised arguments for and against SB 5458.

Bill Sponsors included: Senators Keiser, Pflug, Kline, Becker, Conway, Pridemore, Rockefeller and Parlette.

A few PRO and CON Arguments for Senate Bill SB 5458 include the following:

Staff Summary of Public Testimony: PRO: This bill meets the growing need of the state to fight Medicaid fraud. It will address provider fraud. The bill will bring in money to the state and could bring in more if the False Claims Act qualifies for the federal rebate. It gives the AG the tools to fight Medicaid theft.

The longer statute of limitations will save the cases the AG already has. It will enable the AG to hire staff to fight Medicaid fraud and bring back recoveries to the state. DSHS does have an effective integrity program and a new fraud and abuse detection system. We are concerned about the rising costs of healthcare. Reducing waste and fraud will help to control costs.

CON: The bill will deter physician participation in the Medicaid program. Audit activities are already in existence and federal and state agencies already have activities to recover inappropriate payments. Instead of receiving more money, Washington will get less money  due to the qui tam plaintiff.

This will increase costs due to increased litigation. Seventy-five percent of qui tam cases are for non-meritorious claims. We support Medicaid auditor funding and the AG having the appropriate amount of resources to defend against fraud. The bill contains a bounty hunter provision. Regarding innocent parties, damages should go both ways.
 

Click on the following link to read the SB Report for SB 5458

The marketing and pricing of prescription drugs have led to 180 qui tam cases against drug manufacturers accused of defrauding the government. Allegedly the drug makers are improperly marketing or pricing popular prescription drugs. The HHS is watching these cases carefully.

The Florida False Claims Act helped the Medicare Fraud Strike Force snag 383 fraud cases. The cities of Miami and Tampa saw a significant amount of activity in Medicare Fraud.  The city of Los Angeles took the second spot with 36 Medicare Fraud cases. 

Recently, US Senator Chuck Grassley shared a January 24 letter from HHS outlining progress and status of several qui tam cases and the fight against Medicare fraud.

Click on the following link to read more from on

The Feds Are Investigating How Many Fraud Cases?

- Pharmalot

Today I'm at The Global Business Forum 2011 being held in Miami. It's a national medical conference held at my school (Its all about the "U" baby!) discussing important aspects of health care in America. I enjoyed meeting Donna Shalala who is the President of the University of Miami and is also the former United States Secretary of Health and Human Services. She was amazing well versed on the state of financial developments within the medical community.

The key Panel Discussion piquing my interest is titled Health Care Fraud's Ground Zero: South Florida! This is of course both sad for those of us that live in South Florida. The corporations that put corporate greed first and willfully commit fraud against the government and taxpayers deserve to be punished and fined for wrongdoings. 

Currently, health care is represents only 15% of our Gross Domestic Product. With the new Obama Health Care System in place that percentage is going to sky rocket! Whether you love or hate the new Health Care Laws, as a political fact (and I am not fond of letting the government do anything other than National Defense), I do not believe the Congress has the strength to overturn the system.

In the next 15 years health care costs and services are going to grow to become 20-25% of our entire GDP! That means the baby boomers turning 65 (when they get the right to Medicare) will drive the Fraud Boomers into a feeding frenzy.

Truth be told: I love Its A Wonderful Life. I would give up the entire Qui Tam practice if the fraud would go away. There are so many great and honest people in the World but the bad guys get so much press it seems they are not the exception but the rule. One wish for the next 10 years is that the courageous whistleblowing heroes are not vilified in the press after reporting the fraud against their employer.

Sammie Wilson, pleaded guilty to conspiracy to commit health care fraud. According to court documents, Family Healthcare Group (Family Group) was supposed to provide skilled nursing to Medicare beneficiaries. However, the owner hired Wilson and others to recruit Medicare beneficiaries for the purposes of filing false claims with Medicare.

Court documents show that Family Group used the Medicare beneficiary numbers to submit false claims to Medicare for skilled nursing. In return, Wilson was paid kickbacks for referring beneficiaries for services that she knew were not medically necessary and/or not rendered.

Fraud of any magnitude is not acceptable. Unfortunately, health care fraud, involving Medicare is too common. Concerned citizens with information pertaining to Medicare fraud, should report the fraud immediately. According to the recent numbers, more whistleblowers are stepping forward in reporting fraud.

In a qui tam claim, a whistleblower may be entitled to 15 - 30 percent- of what the government recovers which includes damages for the false bills, tripled, plus civil penalties of from $5,000 to $10,000 per false claim.

Click on the following link to read more from the DOJ on the Houston-area Patient Recruiter Pleads Guilty in a $5.2 Million Medicare Fraud Scheme

The civil settlement resolves three lawsuits filed in federal court in the Northern District of Georgia under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and share in any recovery. The following whistleblowers – Dr. Amy Lang, Charles Rushin, Cher Beilfuss, Kathleen O'Conner-Masse, and Edward Hallivis – will receive $37.8 million from the federal share of the settlement amount.

Tony West, Assistant Attorney General for the Civil Division of the Department of Justice, and Sally Quillian Yates, U.S. Attorney for the Northern District of Georgia, filed charges against Allergan for promoting Botox® for headache, pain, spasticity and juvenile cerebral palsy – not approved by the FDA. According to the criminal charges, Allergan made it a top corporate priority to maximize sales of Botox® for such off-label uses.

Allergan’s off-label marketing tactics included calling on doctors who typically treat patients with off-label conditions. In 2003, Allergan doubled the size of its reimbursement team to assist doctors in obtaining payment for off-label Botox® injections. Allergan held workshops on billing for off-label uses, conducted detailed audits of doctors’ billing records, and provided a Botox® Reimbursement Hotline.

This settlement is part of the government’s emphasis on combating health care fraud.  Since January 2009, the False Claims Act has helped the Justice Department recover approximately $3.1 billion in cases involving fraud against federal health care programs.  The Justice Department’s total recoveries in False Claims Act cases since January 2009 have topped $4 billion.

Click on the following link to read more on the Allergan settlement:
Allergan Agrees to Plead Guilty and Pay $600 Million to Resolve Allegations of Off-Label Promotion of Botox® - DOJ
 
Allergan Will Pay Fine, Plead Guilty to Misdemeanor - Bloomberg

Allergan To Pay $600 Million To Resolve Off-label Marketing Allegations, Agrees To Drop First Amendment Suit - Thompson

The summit was an unprecedented event on health care fraud where law enforcement and the private and public sectors come together as a part of the Obama Administration’s coordinated effort to fight health care fraud. The seminar covered such topics as 

•  Use of technology to prevent and detect health care fraud and improper payments.
• Role of states in preventing health care fraud.
• Development of effective prevention policies and methods for insurers, providers and beneficiaries.
• Effective law enforcement strategies.
• Measuring health care fraud, assessing recoveries and determining resource needs. 

Highlights from some of the key speakers include the following:

Secretary Kathleen Sebelius gave a moving introduction of the significance of the summit. She reinforced the Obama Administration's stance on "zero tolerance" for criminals who cheat  taxpayers, endanger patients, and jeopardize the future of  Medicare. A few highlights from her speach include the following remarks:

"Today, the President has asked us to put these criminals on notic. The problem of health care fraud is bigger than either government, law enforcement or the private industry can handle alone. We will need all of us working together to solve it. In the fight to prevent, find, catch, and prosecute these crooks, we want every good idea we can get.

Health care fraud is a national problem. It affects federal programs like Medicare, state programs like Medicaid, and private insurance companies. We’re all part of a health care system that has been undergoing rapid growth.

Between 1970 and today, America’s annual health care spending has gone from $75 million to over $2.5 billion. That has produced significant benefits for patients. But it’s also created a much bigger target for criminals. And a much bigger challenge for investigators. The difference between catching fraud then and now is the difference between trying to find a penny in a bathtub and trying to find a penny in a swimming pool."

Attorney General Eric Holder stated in his opening remarks that the HHS-DOJ Healthcaree Fraud summit marks a critical step forward in the work being done by HEAT, our Health Care Fraud Prevention and Enforcement Action Team that was established last May. He gave several insightful comments after addressing the fact that we have a serious problem on our hands with healthcare fraud. If the agencies, concerned advocuates and citizens work together, combined forces, more progress will be made.

First, we must strengthen HEAT ( We will continue to combine and leverage our agencies’ resources and expertise, including the FBI,the Office of Inspector General at HHS, and the local U.S. Attorneys Offices to pursue both civil and criminal cases.

Second, we’ll continue to support our Medicare Fraud Strike Forces and work to expand these teams to areas of the country where our efforts are most needed. These teams have changed the enforcement landscape.

Third, we will continue to push for the investments necessary to meet our duties and do our jobs. I’m pleased that Congress and the Administration have provided strong support.

Fourth, our agencies will continue to work with Congress to identify and pursue the legislative and regulatory reforms necessary to prevent, deter and prosecute health care fraud."

Incoming Acting Deputy Attorney General Gary Grindler stated the followng in his remarks:

"Every year, hundreds of billions of dollars are spent to provide health care for millions of American seniors, children, and the disabled. And each year billions of these dollars are stolen through fraudulent schemes that cheat taxpayers and contribute to the increasing cost of health care for all Americans.

We are here today because we know we need to do more. Not only does health care fraud harm the stability of public health care programs, it harms everyone - it drives up the cost of health care, insurance premiums, and taxes for all Americans."

We applaud the efforts of the Obama Administration and the agencies that have come together to address  this critical issue of fighting healthcare fraud.  As Civil Justice Prosecutors, we are vigilant in the prosecution of fighting corruption, especially fraud against the government and taxpayers. The crime and corruption will only stop if the protocols and measures are put in place to uncover the fraud, and prosecutte the criminals that are found guilty.  This will only stop, if criminals, including corporations, understand the significance with huge fines and jail time,where appropriate.

For more information on the fight against Healthcare visit the following sites:

DOJ website on reporting fraud

Stop Medicare Fraud - Government site

 I

The Whistleblower, Kevin Colquitt, filed the qui tam lawsuit under 31 U.S.C. 3729 (False Claims Act) and other State False Claims Act Statutes for violations against Medicare, Medicaid, CHAMPUS and TRICARE.  The lawsuit allegesthat the companies involved, committed Medicare Fraud and filed fraudulent clearance applications with the FDA.

According to the New York Times, the Justice Department and two of those states, Florida and Tennessee, said in court filings that they were declining for the moment to do so, but added that they were continuing to investigate.

Click on the following link: to view the Colquitt Whistleblower Court Documents 

Click on the following links to learn more on this qui tam lawsuit,

Mass Device
The New York Times


 

According to the Department of Justice, Wheaton Community Hospital knowingly made false claims to Medicare for unreasonable and unnecessary hospital admissions. These false claims were made from 1998 to 2004. The hospital billed Medicare for acute patient care that was not medically necessary.

Tony West, Assistant Attorney General for the Justice Department’s Civil Division stated the following:

 "Hospitals and doctors have a responsibility to provide patients with reasonable and necessary care. When they neglect those obligations, patients and taxpayers suffer."

The whistleblower in this case will be awarded $203,150, as his share of the settlement with Wheaton Community Hospital. In a qui tam case, the whistleblower's reward or relator's award can be anywhere from 15% to 30%, depending upon the level of the government's involvement in the case.

If you are a whistleblower and have pertinent information on Medicare, Medicaid fraud or any other false claims act violations from a company, protect your rights and contact a qualified qui tam attorney to discuss how to protect your rights.

The year ended with a qui tam settlement from Genesys Health System in the amount of  $669,413. The lawsuit brought by the Justice Department alleged that  the health care provider violated the False Claims Act by submitting false claims to Medicare.

Genesys, a Grand Blanc, Mich.-based Company, provides health care services through a network of medical facilities located in Michigan. The government alleged that between 2001 and 2007, Genesys violated the False Claims Act by billing Medicare for higher levels of service than were actually rendered to patients. Specifically, the government alleged that Genesys overbilled for evaluation and management services provided to cardiology patients.

Assistant Attorney General of the Justice Department’s Civil Division, Tony West stated:

"We are committed to vigorously pursuing those who defraud Medicare. Taxpayer dollars should be spent on health care services for patients, not wasted on fraud and abuse."

This case was a success due to the coordinated efforts of the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Eastern District of Michigan, and the Office of Investigations for the Department of Health and Human Services’ Office of Inspector General and Office of Counsel to the Inspector General.
 

It started back in 1994 when Mr. Pogue was fired from his job as a marketing representative for a company called Diabetes Treatment Centers of America, (owned by parent company Healthways).. The hard work and tireless efforts for bringing justice on behalf of the United States for the Diabetes Treatment Centers for stealing millions of dollars in taxpayer money through Medicare fraud and illegal kickbacks, paid off inthe recent settlement.

Since the government decided not to intervene, whistleblower, Steve Pogue will collect 25% - 30% of the settlement as a reward.  That comes out to $10,000,000 - $12,000,000 for him stepping forward and bringing forth the qui tam claim. Hopefully settlements like these will encourage more whistleblowers to report fraud against their employers that are stealing from the government.

Legal Blogger, from Getnick & Getnick on QuitamHelp.com, made a valid point in the blog post "Healthways pays $40 million to settle 15 year qui tam suit, when they shared the following statement:

"This case “demonstrates the wisdom of Congress in deciding that the government’s decision not to participate does not mean that a case has no merit.”

Although it took 15 years, the reward was great, Unfortunately, it is not always like this and sometimes the whistleblower doesn't win such a large amount of money.  Wen working with whistleblowers around the country, most step forth and bring fraud to their employer's attention, because they want to do what is right for the company and the government. Unfortunately, most companies fire the messenger or make their lives miserable,. The whistleblower is forced is forced to seek legal counsel and bring the company's fraudulent behavior to the authorities..

Hopefully, the proposed False Claims Act Amendment will give protections to more whistleblowers so that we can prevent taxpayer fraud.  We all lose, when someone defrauds the government.  Let's all be watchful of how companies bill the government and spend government funds.  If the public doesn't keep a watchful eye out for the government, who else will? Definitely not the companies stealing and overcharging the government.

To learn more on this qui tam settlement from Healthways, read Medical News Today

What makes this suit fascinating is that Medicare uses "outlier" payments to hospitals for instances where costs for treating a patient exceed a predetermined reimbursement amount for a particular type of treatment.  One can only imagine how many times hospitals have taken advantage of this loophole to try and take advantage of Medicare billing.

A few other qui tam suits against Hospitals and Health Care Systems include:
Cooper University Hospital in Camden, N. J., $3.85 million settlement.
Warren Hospital in Phillipsburg, N.J., $7.5 million settlement
Bayonne Medical Center in Bayonne, N.J., $2.5 million settlement
Cathedral Healthcare System in Newark, N. J. $5.3 million settlement
Raritan Bay Medical Center in Perth Amboy, N.J. $7.5 million settlement
Grand Total: $26,650,000.00 - In Qui tam/ whistleblower suits against Health Systems

Now, I must caution you to not think that every whistleblower claim produces results like these, because they do not. It takes PROOF and hard FACTS to prove the claim and it takes time.  As most whistleblowers can attest to this fact.

Click here to read more on this whistleblower suit against health systems.

Click here to read more on qui tam statutes and how to file a whistleblower claim.

According to the indictment, The Medicare False Claims Scheme involved recruiting Medicare beneficiaries to go to the Clinics under the false pre-tense of needing HIV infusion services.  Physicians and medical staff were trained to fraudulently show that medical services were performed and medically necessary.

Thanks to the valiant efforts of Deputy Chief Kirk Ogrosky's Strike Force Team and U.S. Attorney R. Alexander Acosta's outstanding prosecutors, this Medicare fraud was uncovered. We applaud their efforts and hard work.

Five Ways we can combat Medicare False Claims fraud and prevent new schemes 

• First,  we can prosecute people and companies that are guilty of Medicare False Claims.
• Second, we can ask for Whistleblowers to come forward and report the fraud/ false claims.
• Third, we can support the Medicare Fraud Strike Force team by ensuring they are adequately funded and staffed to handle the investigations and prosecution.
• Fourth, we can pass stringent legislation that helps prosecute those found guilty of fraud/false claims.
• Fifth, we can make it easier to reward whistleblowers for coming forward and reporting Medicare fraud and Medicare false claims schemes and simplify the process.