Feds Intervene in Alabama Whistleblower Lawsuit Alleging Medicare Fraud

July 26, 2013 — Health care fraud robs taxpayer funds and preys on our most vulnerable community members. Information from tipsters and informants can help federal authorities fight Medicare and Medicaid fraud. The False Claims Act’s qui tam provisions permit insiders to file suit on behalf of the government and to share in a portion of any settlement or judgment.

Alabama Health Care Provider Accused of Paying Illegal Kickbacks to Physicians

The federal government has intervened in a whistleblower lawsuit filed against Infirmary Health System Inc. and related entities IMC-Diagnostic and Medical Clinic P.C., Diagnostic Physicians Group P.C., and Infirmary Medical Clinics P.C. The suit accuses IMC-Diagnostic and Medical Clinic of billing Medicare for services referred by Diagnostic Physicians Group doctors, according to the Justice Department. These referrals were allegedly made in violation of the Anti-Kickback Statute and the Stark Law, making the resulting claims against Medicare fraudulent.

The Anti-Kickback Statute and the Stark Law are meant to prevent financial incentives from interfering with physicians’ medical judgment. Under the Stark Law, clinics or hospitals are forbidden from billing Medicare for services referred by physicians with a financial relationship with the health care provider. The Anti-Kickback Statute prohibits health care providers from offering, soliciting, paying, or receiving money to induce referrals of items or services covered by federal health care programs like Medicare.

The whistleblower lawsuit, filed by a former Diagnostic Physicians Group doctors, alleges that the IMC-Diagnostic and Medical Clinic made improper payments to Diagnostic Physicians Group doctors, including a percentage of the money received from Medicare for services the physicians referred to the clinic. If proven, these payments and the resulting false claims submitted to the Medicare program would violate the Stark Law and the Anti-Kickback Statute.

Insiders Use False Claims Act to Fight Medicare Fraud

Insiders, like the physician in this case, can be vital in the fight against Medicare fraud. Before any insider becomes a government informant, however, it is important to understand the False Claims Act and the rights it provides to whistleblowers. The lawyers at Waters & Kraus can provide the guidance and skills that you need. Contact us by email or phone our False Claims Act attorneys at 855.784.0268 to find out more about our qui tam practice and how we can help you.