The allegations brought by a Medicare fraud whistleblower lawsuit have been resolved in a settlement for $1.7 million.

The Medicare fraud whistleblower case was initiated by relator Holly L. and was filed on Sept. 30, 2016. Holly was a former employee of and complainant against FWC Urogynecology LLC, a group of urogynecologists practicing in the state of Florida, according to Law360.

Holly was employed in the capacity of a physician’s assistant in one of the FWC clinics. She claims she was motivated to file the Medicare fraud whistleblower lawsuit when she questioned some clinic billing practices and was let go shortly afterward. Holly filed a separate federal wrongful termination suit against the defendant as well.

According to the relator—a term for a plaintiff filing on behalf of the U.S. Government—the administration of the clinic where she worked pressured Holly into writing down more expensive patient care activities in charts, so the defendants could bill Medicare at a higher level. Additionally, Holly noted that claims were written in patient charts for procedures yet to be ordered, scheduled or completed.

Holly explained in the Law360 article that she would often find examples of chart notes that were questionable in their content in this clinic setting. She would see written findings that a patient’s cervix and uterus were normal as if they had been examined.

Upon closer review, the patient being referred to had had a total hysterectomy a decade prior. The notes as they were written justified a charge and code for a complete pelvic exam never completed.

The U.S. Department of Justice (DOJ) took on the Medicare fraud whistleblower case and—in reviewing the Medicare claims—noted the frequent use of what is called a modifier 25.

According to the Law360 article, the modifier 25 is code that indicates a physician performed separate care activities in the course of a patient visit which qualifies him or her to receive additional compensation from the public health program.

The DOJ claimed that the scheme involving the use of the modifier, upcharging, and similar activities went on from February 2012 until Jan. 12, 2017. A special agent indicated in the article that the pattern of behavior leading to the Medicare fraud whistleblower lawsuit will continue to be investigated wherever it is found.

There has been no finding of guilt in the Medicare fraud whistleblower lawsuit filed against FWC Urogynecology. The $1.7 million settlement offered the DOJ resolves the clinic network of any claims of wrongdoing against it and partially recovers alleged defrauded Medicare funds. Holly will receive $306,000 as her share for taking the risk to draw the government’s attention to this issue.

What is the False Claims Act?

The False Claims Act is a law of the federal government that imposes strict liability against persons or companies that attempt to take money from public programs by presenting inaccurate or ‘false claims’.

Part of this act is the qui tam provision which allows citizens unrelated to the government to file actions on its behalf. These ‘whistleblowers’ are also called relators and are able to share in a portion of the money regained through associated legal actions.