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Whistleblower Rewarded for Alleging False Claims Act Healthcare Billing Violations Against Eye, Ear, Nose and Throat Healthcare Providers that Resulted in a $2.675 Million Recovery for the Government

The United States Department of Justice settled a case against Massachusetts Eye and Ear Infirmary, Massachusetts Eye and Ear Associates, Inc., and the Foundation of the Massachusetts Eye and Ear Infirmary, Inc. (collectively “Massachusetts Eye and Ear”), healthcare providers and their management company.  Under the terms of the settlement Massachusetts Eye and Ear paid $2.675 Million.

Massachusetts Eye and Ear provides inpatient and outpatient services to people with a range of diseases involving the eye, ear, nose and throat. Over an eight-year period, Massachusetts Eye and Ear improperly billed Medicare and MassHealth (Massachusetts’ Medicaid program) for certain office visits and procedures, allegedly defrauding the United States of more than a million dollars.

The United States contends that between January 1, 2012 and February 1, 2020, Massachusetts Eye and Ear regularly received reimbursements from Medicare and MassHealth for claims for office visits and procedures involving nasal endoscopies and laryngoscopies that were not performed.  Massachusetts Eye and Ear mischaracterized their billing for such procedures since the actual type of office visits and procedures that were performed are not allowed under Medicare and MassHealth.  Thus, as a result of the illegal conduct, Massachusetts Eye and Ear obtained reimbursements to which it was not entitled.

“When health care providers submit improper claims to Medicare and Medicaid, they do two bad things: they unjustly enrich themselves, and they drain money needed for legitimate patient care,” said Acting United States Attorney Nathaniel R. Mendell. “This settlement punishes bad billing and helps safeguard government health care programs from fraud, waste and abuse.”

“Our federal healthcare system relies on the basic premise that providers abide by the rules and bill properly, and the American taxpayers who fund the Medicare and Medicaid programs deserve nothing less,” said Phillip Coyne, Special Agent in Charge, Office of the Inspector General of the U.S. Department of Health and Human Services.

This settlement resolves a lawsuit brought by a whistleblower under the qui tam provisions of the False Claims Act, which allow private parties, known as “relators,” to bring suit on behalf of the government and to share in any recovery.  Whistleblowers are protected against retaliation under the whistleblower provisions of the False Claims Act.  For demonstrating a commitment to protect the integrity of Medicare and Medicaid, the whistleblower in this case will receive 15% of the recovery which is $401,250.

The Department of Justice needs whistleblowers to report healthcare fraud to help protect healthcare programs and patients, and to hold accountable any company that commits fraud, waste or abuse in the Medicare, Medicaid and other government programs.

© 2022 by Tycko & Zavareei LLPNational Law Review, Volume XI, Number 112
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About this Author

Eva Gunasekera WHistleblower and Government Fraud  Attorney Tycko & Zavareei LLP Law Firm
Partner

FORMER DOJ SENIOR COUNSEL FOR HEALTH CARE FRAUD, NOW REPRESENTING WHISTLEBLOWERS

(202) 973-0900
Renée Brooker Whistleblower Lawyer Tycko & Zavareei Law Firm
Partner

FORMER PROSECUTOR IN SENIOR LEADERSHIP POSITION AT DOJ, RESPONSIBLE FOR BILLIONS OF DOLLARS IN RECOVERIES UNDER WHISTLEBLOWER LAWS, NOW REPRESENTING WHISTLEBLOWERS

(202) 417-3664‬
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