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Whistleblower Case Settles for $2.7M

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Eerie, PAA whistleblower case brought by four doctors against Bradford Regional Medical Center (BRMC) and V & S Medical Associates has reached a settlement, with a federal judge awarding $2.7 million to the government and $600,000 in attorney fees and costs. The judge had issued an opinion on summary judgment in 2010 against the medical center.

The qui tam lawsuit was filed in 2004 under the False Claims Act alleging an equipment sublease between the two defendants violated anti-kickback laws and that they had run afoul of a ban on physician self-referrals. This resulted directly in submissions for fraudulent reimbursement from the US government.

The government formally intervened in the lawsuit late in 2011, settling with BRMC for $2.75 million. A settlement hearing is taking place currently with V & S Medical Associates, the remaining defendant, which is approximately one month ahead of the trial date of November 18.

Qui tam is a law passed by Congress that allows a private individual with knowledge of fraud committed against the federal government to act as a government whistleblower and bring about a qui tam lawsuit on behalf of the US. Any situation where a company or individual has defrauded the government comes under the False Claims Act, including Medicare fraud and pharmaceutical fraud.

Qui tam is a provision of the False Claims Act that allows a whistle blower to bring a lawsuit on behalf of the US government for a fraud committed against the United States. A government whistleblower who successfully files a qui tam lawsuit is entitled to receive between 15 percent and 30 percent of the lawsuit settlement funds recovered for the government.

A considerable amount (estimates are as high as 10 percent) of the US annual budget is paid to companies or individuals who defraud the government, usually by overcharging, submitting bills for services never performed, or over-billing for services provided. Qui tam whistleblower lawsuits include government contract fraud, defense contractor fraud, Medicare fraud, Medicaid fraud, pharmaceutical fraud and other public benefit fraud.

Shockingly, as much as 10 percent of Medicare charges are fraudulent. Some examples of fraud are:billing more than once for the same service; charging for services not performed; offering free items or services in exchange for a Medicare or Medicaid number; billing for expensive equipment and only providing cheaper equipment; waiving co-payments routinely; someone other than the physician completing the Certificate of Medical Necessity.

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