A North Carolina prosthetic company is the target of a Medicaid fraud whistleblower lawsuit, with the claim alleging the business wrongfully billed Medicaid on a number of occasions.

According to the Medicaid fraud whistleblower lawsuit, the company A Perfect Fit For You Inc. allegedly billed over $12 million in numerous alleged false billing claims. The prosthetic company had reportedly billed Medicaid for different types of medical products that were never actually bought or provided to in-need patients.

According to the Medicaid whistleblower lawsuit, $9 million of the billing claims were for a number of different prosthetic based medical devices including powered air floatation beds, bone growth stimulation products, power wheelchair accessories, cough stimulation devices, and prostheses for knee, foot, and ankle replacements.

Once the full magnitude of the false claims were uncovered, the federal government described the bills as completely “false and fictitious.” In addition to the billings for the prosthetics, the company had also reportedly billed Medicaid $900 for mastectomy bras and synthetic breasts for a patient who did not have cancer.

The company allegedly billed the state of North Carolina for $26,000 in other medical devices, for patients who allegedly did not need or receive the products in question. Further allegations include that the company billed for devices provided to patients who had actually been dead for over a year, and for products the company supposedly provided long before it opened for business.

Overview of Medicaid Fraud Whistleblower Lawsuit

The allegedly fraudulent billing scheme was noticed by a state court appointed receiver, who was there when trying to determine which party owned A Perfect Fit For You. The federal government was then notified, which spurred the Medicaid fraud whistleblower lawsuit.

Ownership of the company was called into question in May 2016, when two A Perfect Fit For You corporate officers fought over which of them owned the company A county judge eventually transferred the dispute to the North Carolina Business Court, after appointing the receiver and granting an injunction to prevent one of the parties from destroying whatever assets the company had.

The receiver then discovered $12 million in Medicaid payments that did not match up with the billing claims, with the receiver stating: “The company’s lack of payments, orders and/or delivery documents for cough stimulators, pneumatic compressors, specialized air mattresses, osteogenesis stimulators, or knee/ankle/foot orthotics ‘would have been evident to anyone who reviewed the company’s financial books and records.’”

The Medicaid fraud whistleblower lawsuit also points that even if the billings were legitimate, the company should have billed Medicare first instead of going straight to Medicaid.

During the litigation process of the Medicaid whistleblower fraud lawsuit, corporate officers admitted that some of the medical devices they billed Medicaid for were not provided to patients. They disagree about who was responsible for sending the fraudulent claims, however.

Medicaid billing fraud is one of the most prevalent types of fraud against the federal government, costing millions in taxpayer dollars. Whistleblowers are considered very important tools in fraud prevention and recovery, with the government providing incentive and protections to individuals to become whistleblowers.

Whistleblowers will typically be rewarded with 15% to 30% of whatever settlement is recovered, and are protected against harassment and wrongful termination.