Skyline Urology has agreed to pay a $1.85 Million settlement in order to settle claims that the medical company submitted false claims and committed Medicare billing fraud.

According to a statement released by the U.S. Department of Justice on Feb. 25, 2019, Skyline Urology agreed to the $1.85 million settlement to resolve Medicare billing fraud allegations made against the company by the United States.

These claims include that the company submitted improper claims to Medicare for evaluation and management services between Jan. 1, 2013 and Dec. 31, 2016.

The lawsuit was filed under the qui tam provision of the False Claims Act. This provision, often also referred to as a whistleblower provision, allows individuals to sue on behalf of the government, regarding crimes made against the government. Whistleblower lawsuits that result in settlement money will award a share of the money to the whistleblower.

In addition to paying out the settlement amount, Skyline Urology has also entered into an Integrity Agreement with the U.S.Department of Health and Human Services. Under this Agreement, Skyline Urology’s billing practices will be regularly monitored by the Department for three years.

Whistleblower Rights and Protections

If you have evidence that your employer has committed, or pressured you to commit Medicare billing fraud, you may be eligible to receive compensation through a qui tam or whistleblower lawsuit. Whistleblowers who are the first to report fraudulent activity are typically rewarded with between 15 to 30 percent of any resulting settlement.

Additionally, there are laws in place meant to protect whistleblowers from retaliation by the employers they implicate in their lawsuit. Under U.S. law, whistleblowers are protected from the following:

• Being fired or laid off
• Being blacklisted
• Being demoted or denied promotions
• Being denied overtime
• Being intimidated or harassed
• Having their pay or hours reduced

Healthcare employees, billing professionals, pharmacists, and financial consultants have earned over $1 billion from whistleblower settlements regarding Medicare billing fraud, financial fraud, kickback schemes, and other misconduct.

Common Examples of Healthcare Fraud

Medicare and Medicaid billing fraud may be committed by hospitals, pharmacies, medical device providers, labs, physicians, home healthcare agencies, or other medical providers. Fraud may be committed in a variety of ways, including:

• Upcoding in billing, or billing for different services than what was performed
• Ambulance companies entering into kickback schemes with hospitals
• Overcharging for medical devices or services.
• Kickback or illegal referral agreements
• Providing unnecessary services
• Billing services at a physician’s rate when the care was provided by a less qualified or less trained employee

Legal Help May Be Available for Whistleblowers

If you have evidence that your company has committed Medicare billing fraud or other crimes against the U.S. government, attorneys may be able to help you file a qui tam lawsuit and share in any funds that are recovered.