Physicians enjoy one of the United States’ highest paying professions. There are strict rules, however, regarding how physicians are compensated and, importantly, what services federal programs like Medicare and Medicaid can be billed for. Whenever federal programs like Medicare or Medicaid are involved, there is an opportunity for whistleblowers who are willing to come forward and report fraud against the federal government bravely. One of the prohibited acts under the False Claims Act is receiving kickbacks in return for referrals of work. Physicians cannot funnel patients towards certain providers in exchange for bonuses, financial incentives, or other valuable perks.
Are you considering becoming a whistleblower? You will need the help of an experienced whistleblower attorney to guide you through the process. Contact Barrett Law now at (800) 707-9577 to attain the advice you need.
Are You Aware of Physician Referral Fraud?
A recent False Claims Act involving Halifax Hospital Medical Center and Halifax Staffing, Inc. (collectively “Halifax”) demonstrates some key points to look for when asking whether the physician compensation you are aware of violates the False Claims Act. It is important to note that this case settled and that Halifax and the Department of Justice agreed that Halifax would pay $85 million. The whistleblower in this case is entitled to 15% to 30% of that settlement, a massive award.
Here, physicians in Halifax’s oncology group divided a large bonus pool based both on how much they worked and how much work they referred to other providers. The court found that this payment plan was not an allowable bonus based on services that the oncologists personally performed as the law requires, but instead was a bonus divided up based on services individually performed by the group. The bonus was determined based on factors in addition to personally delivered services – including revenue from referrals. The fact that each oncologist could increase his or her share of the bonus pool by performing more services did not diminish the fact that the pool and each bonus could be increased simply by making more referrals. In short, pay, and billing must be directly related to work performed, not others’ work or referrals.
Accordingly, if you are working in a medical environment where pooled compensation is unconnected to services personally performed and is, at least partially, based on referrals to other providers, you are likely witnessing a violation of the False Claims Act’s anti-kickback provisions. This is a technical legal area, and you will require the help of an experienced False Claims Act attorney to help you file your claim.
What Should You Do if You are Considering Making a Whistleblower Claim?
Are you considering filing a whistleblower case? The reward for submitting a successful claim can be significant, 15% to 30% of any amount recovered by the government, but you will only receive this sort of award with the help of an experienced whistleblower attorney. The U.S. Department of Justice receives thousands of potential whistleblower claims each year, and only those that meet their requirements and are reported in a way that triggers their interest are acted upon. Careful pleading and an organized approach to gathering evidence are critical to this process and will require the help of an experienced whistleblower counsel. Contact Barrett Law now at (800) 707-9577.
Experienced whistleblower lawyer Barrett can provide you with the advice you will need to file a successful whistleblower case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower reward and losing your career and livelihood. Call us today.
