A doctor will receive more than $4 million as part of a Florida qui tam lawsuit settlement after blowing the whistle on a dermatologist accused of defrauding the federal government.
Our qui tam attorneys understand that this case goes all the way back to a 1997 agreement the dermatologist reportedly made with a small clinical laboratory - one that involved illegal kickbacks, improper Medicare billing and in some cases even performing unnecessary (and expensive) procedures in order to make more money.
As the former physician employee had done the right thing in bringing it all to light, he will now reap the rewards, per 31 USC 3729, The False Claims Act.
According to the Department of Justice, the dermatologist would take biopsy samples from Medicare patients. Those samples would then be sent to the local laboratory. The lab then returned the results of those tests, except with paperwork that made it appear to Medicare that the dermatologist's office itself had conducted the diagnostic tests. Then, the dermatologist would bill Medicare for that work as if it was his own.
In doing so throughout the course of more than 10 years, he fraudulently collected more than $6 million from the government.
What's more, it appears that a number of those biopsies weren't even necessary. In comparing the sheer number of biopsies the dermatologist ordered prior to that agreement, significant increase was noted -- indicating that many of those procedures were only being conducted so that the doctor could increase the Medicare payouts and the lab could increase its referral business.
The dermatologist was also accused of conducting literally thousands of skin surgeries that were not necessary. Specifically, these were adjacent tissue transfers. This is a complex and lengthy procedure that doctors will sometimes perform in order to close a defect that has resulted from the removal of another growth on a person's skin. Curiously, these were primarily conducted on Medicare patients - and at a much higher rate than one might expect to normally see.
The doctor to bring forth the allegations, filed in the District Court for the Middle District of Florida, was a pathologist who worked at the lab. The doctor who ran that lab had already settled with the government for $1 million.
A qui tam lawsuit is one in which a private-party whistleblower files a lawsuit on behalf of the U.S. government for a violation of false claims. In turn, that plaintiff may collect a share of the recovery. In this case, the whistleblower received 15 percent of the total settlement amount. In some cases, whistleblowers have received even more.
The Department of Justice reports that as of January 2009, its offices have recovered more than $10 billion under the False Claims Act - specifically for federal health care fraud. This is huge not only here in Florida but across the country, as it accounts for the bulk of cases under the False Claims Act. Total U.S. DOJ recoveries under the act since 2009 are just above $14 billion.
This case was reportedly the largest qui tam settlement for the Middle District of Florida.