Whistleblower Provision of the False Claims Act Remains a Tool to Combat Fraudulent Medical Billing

By Chris McCarty | March 17, 2023

According to the Department of Justice (“DOJ”), healthcare fraud continues to be a leading contributor to False Claims Act (“FCA”) settlements and judgments. (LINK to DOJ’s Feb. 7th Press Release).  The FCA settlements and judgments operate to restore funds to the taxpayer-funded government program that has been defrauded.  We are seeing the DOJ consistently use the FCA as a deterrence to healthcare fraud– often through the aid of whistleblowers.

In December 2022, a youth rehabilitation center settled with the DOJ for over $3.4 million after a whistleblower brought forth allegations of fraudulent billing practices. (LINK to DOJ Press Release on the Settlement).  The lawsuit alleged that Pathway of Baldwin County billed Medicaid for “basic living services” that were never actually provided to the youth under their care. (LINK to Local News Release on the Settlement).  The whistleblower claimed that he learned of the improper billing, promptly reported it to the state’s Medicaid agency, and Pathway of Baldwin County fired him in retaliation five months later. When the Government succeeds in FCA suits brought forward by whistleblowers, the law states that the whistleblower stands to receive 15%-25% of any proceeds, or $510,000 – $850,000 in the Pathway case. (LINK to DOJ Article on FCA Laws).

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