Kim Gale  |  September 22, 2016

Category: Labor & Employment

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Medicare and Medicaid Whistleblower LawsuitA former employee who turned in a dishonest doctor in a Medicare fraud lawsuit will receive $200,000 for her whistleblower services, says the U.S. Department of Justice.

Lori M. worked at Clear Vue Eye Center Inc. for Dr. Monique Barbour, who owned the establishment in Lake Worth, Fla.

Lori alleged under the False Claims Act that Dr. Barbour and the clinic were stealing money from Medicare in a variety of ways.

What Prompted the Medicare Fraud Lawsuit?

Lori said she saw the clinic overbill Medicare for medically unnecessary procedures at nursing homes and assisted living facilities.

Not only that, but also some of the billed procedures were supposedly performed when the clinic’s only practitioner was out of the country, according to the Medicare fraud lawsuit.

Dr. Barbour billed for 12-plus hours per day that she supposedly spent at a variety of elder care centers.  Prosecutors noted that she often billed for more than 20 hours in a 24-hour period for procedures that were not medically necessary.

Bills show she invoiced at the most expensive rates despite a procedure’s proper billing code, the Medicare fraud lawsuit noted.

“It is hard to imagine how a single practitioner believed billing for more hours than were possible to perform in a day would not alert law enforcement to a potentially fraudulent scheme,” U.S. Department of Health and Human Services Office of Inspector General special agent in charge Shimon R. Richmond said. “Billing for work supposedly performed while you were physically in another country is a special kind of arrogance and disregard for the ethical care of patients.”

Medicare Fraud Lawsuit: Lori’s Observations

Lori began working as an office assistant at Clear Vue in December 2003. She was promoted to office manager, and saw Barbour enjoying an extravagant lifestyle by committing fraud for 10 years.

According to the Medicare fraud lawsuit, approximately two-thirds of Clear Vue’s patients were on Medicare or Medicaid.

As a result of Lori coming forward, Barbour and her clinic will pay $1 million to resolve the Medicare fraud lawsuit amid allegations they overbilled the government agency for medically unnecessary procedures at elder care homes.

Whistleblowers Have Access to Suspicious Activity

According to the Association of Certified Fraud Examiners, 43 percent of fraud is found through tips provided by someone within an organization. Less than 15 percent of fraudulent activity is uncovered by management or internal auditors, and outside auditors find only three percent.

“No question, whistleblowing is effective,” says fraud expert Kristin Rivera at PricewaterhouseCoopers. “I always say, ‘If you want to find a needle, look in the sewing kit, not the haystack.’ Likewise, if I wanted to find fraud in a company, I’d go to the [whistleblower] hotline.”

More than 55 federal laws protect or reward whistleblowers, and 44 states plus Washington D.C. provide further, albeit varying, degrees of legal protection.

The Medicare Fraud Lawsuit is Case No. 9:14-cv-81099, in the U.S. District Court for the Southern District of Florida.

In general, whistleblower and qui tam lawsuits are filed individually by each plaintiff and are not class actions. Whistleblowers can only join this investigation if they are reporting fraud against the government, meaning that the government must be the victim, and that the alleged fraud should be a substantial loss of money.

Do YOU have a legal claim? Fill out the form on this page now for a free, immediate, and confidential case evaluation. The attorneys who work with Top Class Actions will contact you if you qualify to let you know if an individual qui tam lawsuit or whistleblower class action lawsuit is best for you. Hurry — statutes of limitations may apply.

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Join a Free Whistleblower, Qui Tam Lawsuit Investigation

If you believe that you have witnessed fraud committed against the government, you may have a legal claim. Whistleblowers can only join this investigation if they are reporting fraud against the government, meaning that the government must be the victim, and that the alleged fraud should be a substantial loss of money.

See if you qualify to pursue compensation and join a whistleblower lawsuit investigation by submitting your information for a free case evaluation.

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