March 12, 2013 — Since January 2009, the Department of Justice has relied on the federal False Claims Act to recover in excess of $10.2 billion in cases of fraudulent schemes against Medicare, Medicaid, TRICARE, and other federal healthcare programs. The anti-fraud statute is one of the government’s most effective tools for preventing and reducing fraud against the American taxpayers. Under the qui tam provisions of the Act, a whistleblower (the relator) is authorized to file suit on behalf of the American government and participate in any recovery. If it elects to, the United States can intervene in the lawsuit. If the government declines to take part, the relator moves forward on its own. When the Justice Department intervenes, the relator who collaborates with the government receives a smaller percentage of the recovery. If the government declines to participate, the informant takes home a greater portion of any proceeds.
Dermatologist Pays to Resolve Illegal Kickback Allegations
Steven J. Wasserman, M.D., a Venice, Florida dermatologist, will no longer be eligible to submit any claims for payment to Medicare and he will have to pay $26.1 million to settle allegations of Medicare fraud and False Claims Act violations. According to the Justice Department, Dr. Wasserman began receiving illegal kickbacks in 1997 from Tampa Pathology Laboratory (TPL) and Dr. José SuarezHoyos, the pathologist who owned TPL. The government alleges that in exchange for the kickbacks, Wasserman forwarded biopsy specimens taken from his Medicare patients to TPL for testing. Wasserman is then alleged to have billed Medicare for the work, representing that he, himself, performed the analyses. Wasserman received over $6 million in Medicare payments as a result of the illegal arrangement.
The government’s allegations came to light in a False Claims Act lawsuit filed in federal court in Florida by Alan Freedman, M.D. The former TPL pathologist discovered the alleged health care fraud that Wasserman and SuarezHoyos were involved in. For his share of the recovery, Dr. Freedman will take home $4,046,000.
Medicare Fraud Uncovered by Insider Employees
Most Medicare fraud schemes are eventually discovered by someone inside the health care provider’s operation. Before stepping forward, informants need to learn about their own rights. The experienced lawyers at Waters & Kraus provide whistleblowers with the legal representation they deserve in the fight against health care fraud. Contact us or call our Medicare fraud attorneys at 855.784.0268 to learn more about our qui tam practice and how we can help government collaborators.