A New Jersey doctor has pled guilty to illegal medical billing practices and to conning the government out of millions of dollars in claims.

New Jersey podiatrist Anthony Enrico allegedly billed Medicare for physical therapy services that weren’t provided by personnel qualified to do so. The U.S. Department of Justice estimates he cheated Medicare and insurance companies out of about $3 million over a period of nine years.

Enrico, aged 60, admitted guilt in one count of health care fraud through illegal medical billing practices and waived prosecution by indictment. This illegal medical billing practices lawsuit is under U.S. District Judge Kevin McNulty.

Allegedly, between 2007 and 2016, Enrico claimed he provided certain physical therapy services himself, but allowed others to perform them. He then charged Medicare for those physical therapy services at his rates, claiming that he in fact was the one who performed them.

The others who actually did the work were not qualified to provide these services under Medicare, according to the DOJ. This qualifies as illegal medical billing practices and the DOJ accused the podiatrist of fraudulently charging the government for services not truly provided.

Enrico’s allegedly illegal medical billing practices included billing both Medicare and other private insurers for these physical therapy services.

He has agreed to pay the $3 million in restitution but also faces up to a decade in prison and a fine of up to twice the amount of the loss attributed to the illegal medical billing practices.

Law360 reports that the DOJ said that the credit for the whistleblowing should go to the FBI and the Department of Health and Human Services.

The podiatrist’s New Jersey medical license was also suspended recently because it was discovered by the state medical board that he had been overprescribing opioids to his patients. At least seven patients were thought to have been overprescribed opioids by Enrico.

Interestingly, Enrico’s license to practice medicine in New Jersey was suspended before because of accusations of illegal medical billing practices, performing unnecessary tests, inflating billing claims and not providing proper recommendations for pain management for patients.

Illegal Medical Billing Practices Under the False Claims Act

If there is someone with evidence that another individual or organization is engaging in illegal medical billing practices against the government, that person who “blows the whistle” is protected under federal law.

The federal False Claims Act protects whistleblowers from retaliation by their employer including termination, demotion or harassment. That whistleblower is entitled to file what is called a qui tam lawsuit. A qui tam lawsuit is a lawsuit filed by an individual on behalf of the government to call out wrongdoing like illegal medical billing practices or other fraudulent practices.

The whistleblower can receive relief in the form of monetary compensation or reinstatement of a job. Additionally, a whistleblower may be entitled to twice the amount of back pay he or she missed because of termination.

If you have evidence of wrongdoing by someone against the federal government, you may be protected by federal law and may be eligible to file a whistleblower lawsuit.