Recently, the Early Autism Project Inc. (EAP) agreed to settle allegations that it had committed Medicaid fraud. The settlement agreement with the United States has been reached at $8.8 million to settle the False Claims Act lawsuit, originally brought to the attention of the federal government by a whistleblower.

Specifically, the False Claims Act lawsuit alleged that the EAP created a program meant to maximize its profits by billing Medicaid for ineligible expenses—namely, for time spent while not actively working with the child the therapy is being billed for. Indeed, Medicaid does not pay for therapy services not directly involved with the child the therapy is billed for.

“That the State’s largest service provider for autistic children would defraud government health programs is compounded only by their billing at the expense of taxpayers for misrepresented or nonexistent services—as alleged here,” noted the press release from the Justice Department. “We will continue to work with our law enforcement partners to protect vulnerable patients and preserve government health programs.”

The whistleblower responsible for reporting medical fraud to the government was a former employee of EAP, Olivia Z. Olivia is set to receive around $435,000 as a reward under the False Claims Act for her part in reporting medical fraud and bringing it to the government’s attention.

“Companies that commit to providing intensive behavioral treatment to children with autism, at a pivotal time of that child’s development, should be held accountable if they do not provide the services, but nevertheless request payment for those services,” noted the press release. “The United States Attorney’s Office is committed to protecting the federally-funded programs that make it possible for children with special needs to receive these vital services.”

The Justice Department is often tipped off about False Claims Act litigation by interference from a whistleblower. If you have witnessed some kind of fraud by your employer against the federal government, you may be able to file a whistleblower lawsuit.

Reporting Medical Fraud

Whistleblowers are individuals who report fraud and illegal activities against the government by 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.

A person considering reporting medical fraud or other fraud against the government may worry about being fired or otherwise retaliated against at work. However, there are regulations in place to protect whistleblowers from this kind of retaliation.

A whistleblower, moreover, is typically given an award under the False Claims Act—often between 15 and 30 percent of the money recovered in the subsequent lawsuit. In one case, the former marketer who acted as a whistleblower against AngioDynamics received a $2.5 million whistleblower award for his part in bringing the False Claims Act lawsuit to the attention of the federal government.