Medicare and Medicaid fraud is done in many ways. Three of the most common methods of Medicare & Medicaid fraud are upcoding, overcharging for medical devices and paying kickbacks to physicians that refer patients to receive the devices. All were at issue in a recent settlement a whistleblower lawsuit charging Medicare and Medicaid fraud against medical-device manufacturer, EndoGastric Solutions Inc., of San Mateo, California.
EndoGastric came up with a new device, the EsophyX, to treat gastric reflux in a less invasive way. Nevertheless, according to the suit, it directed doctors to charge Medicare and Medicaid using codes applicable to a more expensive and more invasive procedure -- a classic example of upcoding. The suit, which was brought by former employee, also charged that the company paid kickbacks to physicians to encourage them to use the device. The total of the settlement was $5.25 million. The whistleblower stands to receive approximately $945,000.
Source: Washington Times
This whistleblower lawsuit was brought under a federal law known as the False Claims Act. The False Claims Act permits individuals to bring suits against companies and contractors that have defrauded the federal government. A common example of such suits is this type case where there is Medicaid and Medicare fraud based on practices such as upcoding, overcharging for medical devices and paying kickbacks. Whistleblowers by law are to receive 15-25% of the amount recovered in the suit.
The False Claims Act also makes it unlawful to retaliate against an employee who has tried to stop a practice aimed at submitting a false claim for who reports the actual submission of a false claim.
Lexington, Kentucky Medicare and Medicaid fraud lawyer represents individuals and employees and whistleblower lawsuits under the False Claims Act; contact him at 859-254-7076.