Allegiance Health Management recently came to a settlement, paying over $1.7 million to close out claims of medical billing fraud. False Claims Act allegations are often brought by those people who have inside information that someone is participating in medical billing fraud.

Medical billing fraud costs taxpayers a great deal of money and is often discovered after a person known as a whistleblower or an individual who has inside information about the perceived fraud comes forward and tells government officials about their concerns.

There are protections afforded to those individuals who trigger investigations and lawsuits under the False Claims Act, and these employees or other insiders are also protected from retaliation against the parties accused of medical billing fraud.

The justice department announced in early June that Allegiance Health Management, based in Louisiana, as well as four of the hospitals operated and owned by Allegiance will be paying over $1.7 million to resolve False Claims Act accusations.

These accusations stated that the defendants submitted, encouraged or were involved with a scheme for other hospitals to send in reimbursement claims to Medicare for services that were not necessary or medically reasonable.

According to the medical billing fraud claims initiated under the False Claims Act, Allegiance used schemes with numerous hospitals all over the southeastern region of the United States since 2005 to provide comprehensive outpatient psychotherapy services for patients on behalf of the hospital.

There were growing concerns over allegations that these services were given to Medicare beneficiaries who did not meet the guidelines for Medicare reimbursement because the medical conditions that the patients had did not require IOP treatment.

Additionally, there were concerns that the patients’ treatments weren’t given in line with an individualized treatment plan, that the patient’s progress was not appropriately tracked or documented, that the patients received an inappropriate treatment level or that the therapy was primarily diversional or recreational in nature and therefore, wasn’t therapeutic.

This medical billing fraud lawsuit was initially filed in the eastern district of Arkansas through a whistleblower provision in the False Claims Act which enables private parties who have insider knowledge about the alleged fraud to file suit on behalf of the United States Government for false claims.

This enables whistleblowers to receive a portion of the government’s recovery. A man who worked as a program manager for the Inspirations Outpatient Counseling Center in Mississippi initiated the lawsuit.

In order to encourage those who have insider information about illegal activity to come forward, the creators of the False Claims Act enabled whistleblowers to earn a portion of any settlement achieved with the government, either in or our of court.

Furthermore, by establishing firm protective anti-retaliation guidelines for qualified whistleblowers, anyone who follows the proper channels to share medical billing fraud might also have a claim against an employer who attempts to demote or harass the employee.

If you or someone you know has become aware of information that may include medical billing fraud, you may be eligible to participate in a False Claims Act lawsuit brought forth on behalf of the government.