A False Claims Act lawsuit filed over Medicaid and Medicare fraud allegedly committed by a group of assisted living doctors has been settled for $4 million.

A group of doctors working for a dermatology practice caring for senior living residents was hit with a FCA lawsuit, alleging that the doctors committed Medicaid and Medicare fraud by billing for reimbursements on therapies that were not medically necessary.

According to the whistleblower lawsuit, the doctors submitted false Medicaid and Medicare fraud claims for superficial radiation therapy to treat non-melanoma skin cancer. The lawsuit alleges that, between 2011 and 2016, the doctors did not adequately supervise superficial radiation therapy, up-coded claims (that is, billed for a more expensive version than was used) for superficial radiation therapy procedure, and over-used radiation simulations.

“The rules are simple: bill government health programs only for services actually needed and provided. No more, no less,” said Shimon R. Richmond, special agent in charge for the Office of Inspector General of the U.S. department of Health and Human Services. “We will continue to protect federal healthcare programs and beneficiaries by holding providers accountable.”

The qui tam lawsuit was originally brought to the attention of the federal government by a dermatologist acting as a whistleblower. The whistleblower had previously filed whistleblower lawsuits against another dermatologist in 2013 and 2014, which were settled for $18 million.

The Justice Department is often tipped off about False Claims Act litigation by interference from a whistleblower.

Filing a Whistleblower Lawsuit over Medicaid and Medicare Fraud

Whistleblowers are individuals who report the fraud and illegal activities against the government of 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 becoming a whistleblower on behalf of 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.

While a person considering becoming a whistleblower may be worried that they will face retaliation for their actions in reporting Medicaid and Medicare fraud, the whistleblower is typically given a whistleblower award—often between 15 and 30 percent of the money recovered in the subsequent lawsuit.

In this case, the dermatologist who acted as a whistleblower against the dermatology practice would have received between half a million and a million as a whistleblower award for his part in bringing the False Claims Act lawsuit to the attention of the federal government.