After just under a decade since a whistleblower lawsuit was filed, the federal government has announced a Medicare fraud settlement of roughly $32.5 million.

The lawsuit was brought against several health care insurers and providers by the late Dr. Darren D. Sewell back in 2009. The lawsuit was filed under the False Claims Act.

In his whistleblower lawsuit, Dr. Sewell alleged that the health insurers, Freedom Health and Optimum Healthcare in Florida, committed Medicare fraud. The lawsuit claims that these insurers took advantage of the system by either falsifying or exaggerating patients’ health in order to squeeze more federal money out of Medicare, purportedly to treat those patients.

Sewell also alleged that both Freedom Health and Optimum Healthcare petitioned for and received permission from Medicare to allow them to expand their health insurance offerings in Florida. However, the lawsuit says, the companies did not have the number of doctors that would be required for the expansion they touted.

Approximately $16.7 million of the Medicare fraud settlement money will go towards settling allegations of risk adjustment fraud. The other $15 million will go towards the claims of fraudulently expanding their services. The risk adjustment Medicare fraud settlement is one of the largest of its kind in U.S. history.

Dr. Sewell worked at Freedom Health and Optimum Healthcare between 2007 and 2012. He served as chief medical officer, and later transferred to work as the vice president of special projects for the Medicare Revenue Management Department. While working in these positions, Dr. Sewell learned about the scams these health insurers were running against Medicare.

Unfortunately, Dr. Sewell died in 2014, before the Medicare fraud settlement was reached. His portion of the settlement money will go towards his estate, where it can benefit his daughter, parents, and brothers. In whistleblower cases filed under the False Claims Act, whistleblowers are entitled between 15 and 25 percent of the Medicare fraud settlement fund.

In a press release from the U.S. Department of Justice, Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division commented, “Today’s result sends a clear message to the managed care industry that the United States will hold managed care plan providers responsible when they fail to provide truthful information.”

Whistleblower Lawsuits

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. While a person considering becoming a whistleblower may be worried that they will face retaliation for their actions, federal law provides certain protections against such retaliation.

If the case is successful, the whistleblower is typically given a substantial reward — often between 15 and 30 percent of the money recovered in the subsequent whistleblower lawsuit.

If you believe you have witnessed some kind of fraud by your current or former employer, you may be able to file a whistleblower lawsuit (also known as a qui tam lawsuit) against your employer on behalf of the government.