The U.S. government brought a False Claims Act lawsuit against a doctor and his podiatry practice, alleging he committed healthcare fraud against Medicare.

According to the lawsuit, Lexington Foot and Ankle Center and its owner, Dr. Michael Allen, engaged in systematic fraud against Medicare and the Federal Employee Health Benefits Program, violating the False Claims Act. 

The company is accused of submitting false claims for routine foot care procedures that were not medically necessary and therefore did not qualify for reimbursement. On top of this, the lawsuit claims. Dr. Allen directed the company to submit false claims for evaluation and management services, despite the fact that neither he nor other employees at the Foot Center actually provided these services.

This fraudulent scheme allegedly lasted from Jan. 1, 2012, through the present, the lawsuit claims, resulting in losses of more than $1 million from these federal programs.

This is not the first False Claims Act lawsuit filed against the Foot Center and its owner. Indeed, one previous such lawsuit was settled in 2010 for alleged misconduct. That lawsuit’s allegations included billing Medicare for other medically unnecessary treatments—in this case, trimming toenails was claimed as nail debridement. Nail debridement is a significantly different service than simply trimming toenails.

The same allegations of filing claims for nail debridement when the real service provided was trimming toenails appear in this lawsuit as well. The government argues that Dr. Allen is well aware of the difference, having been challenged over it in the previous litigation, and thus the false claims were made knowingly.

Moreover, the lawsuit claims, Dr. Allen allegedly trained his staff to use template language worded precisely to maximize the amount of reimbursement. Patients’ records included vague stock phrases, the lawsuit alleges, rather than real records of symptoms.

In one case, Dr. Allen allegedly told a podiatrist working at the Foot Center to always indicate “that a patient had pain, onychomycosis, or trouble walking to ensure claims were paid. Dr. Allen also told her that everyone suffers from atherosclerosis…and [the podiatrist] witnessed Dr. Allen documenting the diagnosis even when a patient did not have atherosclerosis.”

Filing a False Claims Act Lawsuit

This lawsuit alleging $1 million in false Medicare claims is a type of claim that can be initiated by someone acting as a whistleblower. After the whistleblower files their own suit, the government investigates and has the option of intervening in the lawsuit.

If you have witnessed fraud against the government by your current or former employer, you may be able to file a whistleblower lawsuit on behalf of the federal government under the False Claims Act. Some who are in this position may worry that coming forward with the result of retaliation for blowing the whistle, but there are laws in place meant to protect whistleblowers who come forward in these situations—plus, there is often a substantial reward.

Generally, whistleblowers are awarded between 15 and 30 percent of and money recovered because of the lawsuit. For major False Claims Act lawsuits, this can often lead to an award of hundreds of thousands—or even millions—of dollars.

If you have witnessed fraud against the government, you may be able to act as a whistleblower and call attention to the problem on behalf of the government.

The False Claims Act Lawsuit is Case No. 5:18-cv-00628-REW, in the U.S. District Court for the Eastern District of Kentucky, Central Division at Lexington.