A Los Angeles-based oncology practice has agreed to pay $3 million to the federal government to settle claims of Medicare fraud. The original whistleblower lawsuit was filed on behalf of the federal government in 2016 by a retired health care consultant under the federal False Claims Act (FCA), which entitles the person who brings the case to a percentage of the recovery.

Allegations

The Nassir Medical Group, Inc. (doing business as Cancer Care Institute), along with its proprietor, Dr. Youram Nassir, was accused of billing Medicare and Medi-Cal programs for medications that were never purchased or prescribed and treatments that were never given. The allegations were investigated by the Department of Health and Human Services and the Office of the Inspector General.

Without admitting liability, Dr. Nassir and his company agreed to pay $2.7 million to the federal government and an additional $979,000 to the state of California.

About Whistleblower Law

A whistleblower is an individual who brings a complaint on behalf of the government in exchange for a portion of any financial recovery. The legal term is qui tam, which is short for the Latin expression, qui tam pro domino rege quam pro se ipso in hac parte sequitur, translated as “[s/he] who sues in this matter for the king as well as themself.” As this phrase suggests, the concept of whistleblowing goes back many centuries, with precedents in Roman and ancient Anglo-Saxon jurisprudence.

In the United States, the False Claims Act is commonly known as the Lincoln Law, named after the 16^th president, Abraham Lincoln. However, the first whistleblower law was actually passed in 1778 after two officers of the Continental Navy reported their commander for misconduct. The modern FCA was passed during the American Civil War after a case in which financier J.P. Morgan was accused of providing the Union Army with defective armaments.

The FCA and Medicare Fraud

Due to the nature of the profit-based U.S. health care system, Medicare – a taxpayer-funded system administered by the states – has become a frequent target for fraud and abuse by unethical providers who seek to “milk the system.” Indeed, Medicare fraud is the most common cause of action in whistleblower lawsuits. It can take a number of forms, which include:

• Phantom billing: When a provider bills the program for unnecessary procedures, tests and treatments that were never performed and medications that were not delivered
• Patient billing: When a patient acts as an accomplice in exchange for kickbacks
• Bill inflation: When a provider claims a patient requires expensive procedures

Between January 2009 and June 2012, the Department of Justice recovered more than $7.7 billion in Medicare fraud prosecutions.

Filing a Qui Tam Lawsuit

Anyone who is aware of Medicare fraud or other type of malfeasance can file a whistleblower lawsuit. Although the FCA provides legal protections for whistleblowers, it is typically a good idea for a whistleblower to retain legal counsel from an attorney who is experienced in qui tam law.

This article is not legal advice. It is presented
for informational purposes only.