Two physicians have been hit with a new lawsuit over alleged Medicaid fraud and abuse during the time they were still practicing physicians. The lawsuit also targets the doctors’ business entities.

The physicians are Don W. and Marilyn W., Indiana residents, husband and wife, and the center of a lawsuit over Medicaid fraud and abuse. Don and Marilyn are now in their 80s, but the lawsuit alleges that while they were still practicing medicine at their medical center, they filed false claims with Medicaid, abusing the system and resulting in an overpayment of more than $1 million over the years.

According to the lawsuit, Don and Marilyn routinely required that patients seeking pain medication like opioid pills submit a urine sample to check for drug use.

First, the defendants would allegedly test the urine sample that same day with a cheap screening kit costing them no more than five dollars. Then, they would allegedly bill Medicaid for $171.27 per patient, telling Medicaid that they had collected and analyzed several separate urine samples, when they had really only analyzed one.

This was not a one-time occurrence, the lawsuit claims: this pattern of Medicaid fraud and abuse was intentional and ongoing over the course of several years. All in all, the defendants allegedly did this same thing with over 6,400 individual claims, ultimately receiving an overpayment of more than $1.1 million.

Under the federal False Claims Act and state laws, the government can recover three times the amount taken via Medicaid fraud and abuse, as well as an additional penalty per false claim submitted. The penalty can range from $5,500 to $11,000 each, which adds up quickly.

These defendants surrendered their medical licenses in 2013 as part of a state criminal investigation into the opioid prescription practices. Don W. was convicted of felony drug dealing.

Medicare and Medicaid fraud and abuse is a significant priority for the Justice Department’s Commercial Litigation Branch. “Working to recover taxpayer funds taken through fraud and other illegal means is part of our responsibility as stewards of the public trust,” according to the Indiana Attorney General, Curtis T. Hill, Jr.

He goes on to say, “We appreciate the collaboration of our federal partners in this particular case, and we intend to remain vigilant going forward to make sure monies set aside to help society’s most vulnerable members are truly used for that purpose.”

Filing a Whistleblower Lawsuit Over Medicaid Fraud and Abuse

Whistleblowers are individuals who report illegal activities against the government like Medicaid fraud and abuse committed by either their current or former employers. Many employees choose to come forward as whistleblowers because they do not feel right about their employer’s actions.

A whistleblower lawsuit can be filed while working at the company, but can also be filed after having left the company.

While a person considering becoming a whistleblower may be worried that they will face retaliation for their actions, there are regulations in place to protect whistleblowers from such retaliation.

Plus, if the claim results in a settlement or final judgment, the whistleblower is typically given a substantial reward—often between 15 and 30 percent of the money recovered in the subsequent whistleblower lawsuit. In this Medicare fraud lawsuit, the whistleblower was given $2.43 of the $13.45 million total settlement money, or around 18 percent.

If you believe you have witnessed Medicare or Medicaid fraud and abuse, or other government fraud by your current or former employer, you may be able to file a whistleblower lawsuit (also known as a qui tam lawsuit) against your employer on behalf of the government.