A woman from Lake Worth, Fla. will receive $200,000 in a Medicare whistleblower award after she blew the whistle on her former employer.

Lori Moore worked in the billing department of Clear Vue Eye Center for several years. Her supervisor was Dr. Monique Barbour.

Moore noticed, after awhile, that the numbers didn’t seem right. She said that Dr. Barbour seemed to be participating in “[u]pcoding, bundling, billing for services that were never rendered.”

Each Medicare procedure is associated with a code. When a provider sends a bill to Medicare for a higher paying service than the one rendered, this is called upcoding.

Most of the time, services that “go together” or are smaller parts of a larger procedure are billed together, or bundled.

Medicare fraud can occur when these smaller parts are unbundled, or billed separately. These can be billed at a higher rate than when they are bundled.

Moore went on to say that “When you start running down how many patients she sees in a day…it just doesn’t add up.”

She also began to question the doctor’s extravagant lifestyle. Dr. Barbour had multiple homes and took frequent, lavish trips. She also allegedly had a secret life as an aspiring pop star.

Moore blew the whistle on Dr. Barbour’s illegal activities, but Dr. Barbour reportedly fired her. Moore’s attorney said, “It’s often times employers will fire whistleblowers when they try to tell the truth and get fraud stopped.”

Fla. Woman Receives $200,000 Medicare Whistleblower Award

Moore brought her case to federal court in the hopes of receiving a Medicare whistleblower award.

Her attorney also said, “The Department of Justice and U.S. Attorneys agreed with our client Lori Moore that Dr. Barbour and Clear Vue were illegally billing Medicare.”

As a result, Dr. Barbour agreed to pay back $1 million to the government.

Moore will receive $200,000 in a Medicare whistleblower award settlement.

Whistleblower Protection

Cases such as Moore’s and other Medicare fraud claims fall under the federal False Claims Act.

The False Claims Act allows a private person with evidence of fraud against the government to open what’s called a qui tam lawsuit.

The False Claims Act was signed into law by President Abraham Lincoln in 1863. The False Claims Act allows for the whistleblower to claim a portion of the proceeds if the qui tam lawsuit is successful.

In this case, Moore’s Medicare whistleblower award was a portion of the $1 million her former employer had to pay to the government.

But the False Claims Act also protects such people from retaliation from their employers.

But the False Claims Act also protects such people from retaliation from their employers. One section of the False Claims Act provides for all relief necessary to make whole any employee who is discharged, demoted, harassed, or otherwise discriminated against because of initiating a qui tam lawsuit.

This “relief” may include compensation for any damages suffered as a result of the retaliation, court costs and attorney’s fees as well as reinstatement to the whistleblower’s old position. They may also be entitled to twice the amount of back wages they missed.