The whistleblower involved in a Bay Sleep Clinic Medicare billing fraud lawsuit is set to receive a whopping $545,000 as a reward for their part in alerting the government, the Department of Justice announced.

The settlement, which amounts to $2.6 million total, puts an end to the Medicare billing fraud allegations that Bay Sleep Clinic, a California company, violated the False Claims Act.

The whistleblower who drew attention to the alleged Medicare billing fraud worked for eight years as a marketer and sleep technician. The whistleblower, Elma D., filed her whistleblower lawsuit in April 2012.

According to the lawsuit, Bay Sleep Clinic committed a number of Medicare billing fraud violations. Firstly, that the company and its affiliates allegedly defrauded Medicare by hiring unqualified staff to run its sleep studies, offered certain products (including sleep-disorder products and sleep testing) at non-approved locations, and allowed staff to prescribe, devise and pay kickbacks.

The lawsuit also alleges that Bay Sleep Clinic’s billing agent, Access Medical Consultants, was actually aware of these violations and participated in the Medicare billing fraud by helping to submit these false claims.

Although Elma’s initial Medicare billing fraud lawsuit was filed in 2012, the United States didn’t enter the scene until May 2015, and shortly thereafter filed its Medicare billing fraud complaint in September 2015.

An amended complaint was eventually filed in August 2016, noting that two of its affiliates, Qualium and Amerimed, falsified documents to claim that sleep tests Bay Sleep Clinic performed at unapproved facilities were instead performed at approved locations.

Providers of these sleep test services are required to receive proper certification prior to offering these services, as well as use approved locations.

The False Claims Act, a set of federal rules prohibiting kickbacks and fraudulent Medicare claims, can result in severe damages and penalties per false claim.

The $545,000 reward given to the whistleblower amounts to 21 percent of the total settlement money.

Filing a Whistleblower Lawsuit

Whistleblowers are employees or former employees who see potential fraud or illegal activities in their workplace against the government and report the fraud in a whistleblower lawsuit.

Although whistleblowers may be current employees of the company committing fraud, they are often former employees reporting fraud that they witnessed while at their job.

Indeed, many potential whistleblowers may be worried that they will get in trouble for reporting fraud, and choose to keep silent, or wait until they have left their position to accuse their former employers of fraud.

However, whistleblowers are often given a substantial whistleblower reward for their reports, which can be between 15 and 30 percent of the settlement money from a lawsuit. In the case of this Medicare billing fraud lawsuit, the whistleblower was given a 21 percent award.

If you believe you have been witness to some kind of fraud against the government, such as Medicare billing fraud, you may be eligible to file a whistleblower lawsuit on behalf of the government.