Former president of an Aveta Inc. subsidiary in Puerto Rico is fighting to keep his whistleblower Medicare fraud lawsuit afloat, in asking a federal judge not dismiss this $1 billion False Claims Act lawsuit.

The former president is arguing that the claim should not be dismissed based on how he obtained certain documents pertaining to the whistleblower Medicare fraud lawsuit, because he did so legally.

In addition, he argues the False Claims Act allows for privileged documents to come through if the claims rely on those said documents.

Plaintiff Jose V. states Aveta’s Medicare Advantage plans had collected $1 billion in government Medicare from overpayments, and is filing this whistleblower Medicare fraud lawsuit.

According to his filing, the False Claims Act (FCA) allows whistleblowers to use documents collected under legal circumstances or in typical business transactions to bring claims against employers.

Jose is fighting Aveta’s motion to dismiss, stating he obtained those confidential documents legally and that he had collected them from the different devices he used for work.

From this, Jose states the documents were collected during routine business transactions and were stored in the devices according to protocol.

Overview of Whistleblower Claims

Under the False Claims Act, whistleblower lawsuits are the only way for individuals to report fraud and to collect a monetary reward.

Whistleblower lawsuits are one of the most important tools in combating government fraud in the United States, with tipsters eligible for additional reward should a settlement come from their whistleblower claims.

Whistleblowers must be the original source of the allegations, and may receive 15% to 30% of the money the government recovers from the whistleblower lawsuit.

There are several types of government fraud, with Medicare being one of the most commonly reported.

This kind of fraud is found when healthcare providers bill the government for unnecessary or services never received by a Medicare or Medicaid patient. Medicare fraud is typically committed by hospitals, physicians, pharmacies, and other healthcare services.

Jose filed his whistleblower Medicare fraud lawsuit after allegedly witnessing one or more of these events transpiring. However Aveta representatives state that Jose did not legally obtain these “privileged and confidential documents”which were allegedly collected after his termination.

Furthermore Aveta alleges that Jose collected these documents to build up his case, and had ultimately failed to explain how there was any Medicare fraud. Jose had been president for eight months of MSO, the Aveta subsidiary, where had had repeatedly asked and spoke out against overbilling Medicare.

Eventually Jose was fired allegedly without warning or reason, in which he claims was retaliation for speaking out against the company’s Medicare fraud.

Jose filed his whistleblower Medicare fraud lawsuit in 2014, stating that at least from January 2007 through January 2012 that Aveta and its subsidiaries had committed “rampant fraud.”

The defendants he named his whistleblower Medicare fraud lawsuit included Aveta’s two Medicare Advantage plans in Puerto Rico, MMM Healthcare Inc., and PMC Medicare Choice Inc.

According to his whistleblower Medicare fraud lawsuit, Aveta and its subsidiaries had collected as much as $350 million annually from the overcharged Medicare Advantage payments. The company allegedly did this by falsifying the risk adjustment scores.

This Whistleblower Medicare Fraud Lawsuit is Case No. 3:15-cv-01140, in the U.S. District Court for the District of Puerto Rico.