Earlier this month, a whistleblower lawsuit was settled as Tennessee-based OPKO Health and Dr. Jonathan Oppenheimer agreed to pay $9.35 million back to the federal government.

The whistleblower alleged that the Tennessee drug testing laboratory and its former owner illegally billed Medicare for patients referred by physicians whose electronic health records systems they helped fund.

The False Claims Act

This whistleblower lawsuit falls under the Federal False Claims Act. The FCA states that any citizen may file a lawsuit, called a qui tam lawsuit, on behalf of the federal government for abuse and fraud in federal spending. It is thought of to be the most effective tool in combating fraud against the federal government.

Between 1986 and 2015 the federal government recovered over $48 billion as a result of claims filed under the FCA. Nearly one half of these claims and most of the largest settlements have been healthcare fraud related.

Not only does the FCA deal with healthcare fraud and Medicare fraud, but it has been very helpful in combating fraud and abuse in other areas of government such as energy, construction, housing and natural disaster recovery.

OPKA Whistleblower Lawsuit Allegations

Drug testing laboratory, OPKA Health Inc. and its former owner,  Dr. Jonathan Oppenheimer, have settled with the U.S. government for $9.35 million to answer allegations that they provided funding to doctors for electronic health record systems in return for Medicare referrals.

The allegations stated that both OPKO and Oppenheimer violated the FCA, the Anti-Kickback Statute and Stark Law by helping those doctors office purchase equipment. They allegedly acted outside of the Anti-Kickback Statute and Stark Law which would have made donations such as this legal.

According to those laws, some companies can pay up to 85% of the cost of equipment like that and still remain under the law, but there are certain restrictions.

In 2013, drug testing facilities, including OPKA, were removed from the list of entities that could participate these kinds of practices legally.

But even previous to 2013, Dr. Oppenheimer and OPKA allegedly violated the laws by making decisions based on the volume of Medicare referrals they could potentially receive from physicians.

According to the whistleblower lawsuit, sometimes they withheld promised donations until the Medicare beneficiaries reached a certain number.

In essence, the laboratory traded free computer software for patient referrals. The Department of Health and Human services calls these “kickbacks that stifle competition and steer business to the company offering the inducements.”

Also, in 2012 the government determined it wouldn’t cover a certain type of genetic testing to map the genetic material in the human cell, however OPKA Health, Inc. allegedly continued to bill Medicare for those tests anyway, committing Medicare fraud.

OKPA Health Inc. and Dr. Jonathan Oppenheimer did not admit that they violated any laws, however, Oppenheimer has agreed to not participate in any federal health care programs for the next five years.

In this case, the whistleblower received a portion of the settlement totaling $1.683 million.

When the Department of Health and Human Services investigated the alleged misconduct, they found that it corroborated with the original whistleblower lawsuit. Qui tam provisions of the FCA allow that whistleblowers can file suit on behalf of the government.

The OPKA Health Whistleblower Lawsuit is Case No. 3:13-cv-00700, in the U.S. District Court for the Middle District of Tennessee.