One of our clients has received a significant whistleblower reward for reporting Medicare fraud.
The fraud was discovered when our client reviewed his Explanation of Benefits (EOBs) from Medicare and a supplemental insurance plan. He noticed that his hyperbaric oxygen therapy provider had billed Medicare for two doctors to supervise his treatments. He became suspicious because he had never met one of the doctors, and the other doctor was never present during his treatments.
We analyzed all the EOBs and found a pattern of fraudulent billing. For example, on some dates, one doctor billed Medicare for supervising a therapy session while the other doctor billed the supplemental insurance plan for supervising the same therapy session.
We conducted an investigation of both doctors and found that the doctor our client never met was employed at a hospital more than 100 miles away from the clinic where he supposedly supervised our client’s therapy sessions.
After we filed a qui tamor whistlebower lawsuit under seal (that is, in secret), the government conducted an investigation that turned up other instances of false billing.
Faced with overwhelming evidence of their guilt, the defendants agreed to pay restitution to the Medicare program. One defendant also agreed to a lifetime exclusion from all government healthcare programs.
Portions of the court filings remain under seal, but we are able to reveal this much: Our client was awarded 17% of the total amount recovered by the government, and the defendants paid 100% of our legal fees. The case is U.S. ex rel. Greenfield v. Hyperbaric Medicine of New York, P.C., No. 14 Civ. 4744 (E.D.N.Y.).
If you have evidence of Medicare of Medicaid fraud, you may be entitled to a substantial reward. Call us at (212) 601-2728. You can also download our free guide to “Whistleblower Rewards and Protections” at https://howleylawfirm.com/free-resource-whistleblower-rewards/