A recent qui tam case has reached a settlement through the efforts of several government agencies including the U.S. District Court for the Middle District of Florida, the Federal Bureau of Investigation (FBI), the U.S. Department of Health and Human Services Office of Inspector General (DHHS-OIG), and the Florida Medicaid Fraud Control Unit.

The qui tam case was originally started by Dr. Theodore S., a registered dermatologist in the Florida. The case was filed under the False Claims Act, which seeks to protect government public health programs such as Medicaid and Medicare allows for private citizens to initiate lawsuits. A whistleblower qui tam case can be based upon the citizen’s knowledge or severe suspicion of fraudulent presented claims against said programs.

The whistleblower qui tam case was brought against Dermatology Healthcare LLC, and the principal owners and agents of the clinic. The defendants stood accused of sending in false claims for non-melanoma skin cancer treatments involving superficial radiation therapy. The time frame for said false claims was a five-year period from Jan. 1, 2011 to Dec. 31, 2016.

The defendants are said to have used radiation treatments where they weren’t necessary and failed to adequately oversee the administration of them. They also were accused of ratcheting up charges in a process known as upcoding. While no allegations have been proven, a recent settlement of $4 million will resolve these accusations outside of court.

In this qui tam case as in others, the citizen who alerts the government earns the right through the qui tam provisions of the False Claim Act to share in a portion of the recovered funds should the government choose to investigate the legal action. The whistleblower, a Palm Beach County dermatologist, will potentially take home 15 to 25 percent of the settlement with Dermatology Healthcare LLC and its associates.

Whether or not the charges have been proven, the $4 million settlement in this qui tam case is considered a win in terms of holding accountable providers who may attempt to defraud vital public programs.

In the U.S. Department of Justice (DOJ) press release concerning the recent resolution, Eric W. Sporre, Special Agent in charge of the FBI Tampa Division, states, “Protection of these important programs is a shared responsibility which can best be accomplished with the support of an engaged community willing to bring these abuses to the attention of authorities.”

Have you witnessed upcoding, the filing of claims for services not rendered, or other abuses of the Medicare or Medicaid program in your place of employment? If you care to present a whistleblower qui tam case, you could be rewarded with a portion of the funds recovery and help the U.S. government hold fraud at bay by holding individuals and agencies accountable.

The Qui Tam Case is Case No. 8:15-cv-1506-T-23AEP in the U.S. District Court for the Middle District of Florida.