September 26, 2013 — Every year, the U.S. Justice Department (DOJ) relies on unique information from whistleblowers to recoup millions of dollars that might otherwise be lost to fraudulent Medicare schemes. The qui tam provisions in the federal False Claims Act give health care insiders who discover Medicare fraud the means to do something about it. In exchange for filing a lawsuit on the government’s behalf, whistleblowers receive a portion of the eventual proceeds from the suit. Health care employees are often ideally situated to collaborate with the government about unethical health care providers.
“No Show” Physician Receives 151-Month Prison Sentence for Role in Medicare Fraud Scheme
New York physician Gustave Drivas, M.D., has received a 151-month prison sentence for participating in a $77 million Medicare fraud operation. In addition, Drivas has been ordered to forfeit $511,000 and to pay restitution of $50.9 million. The Staten Island doctor’s medical license was revoked earlier this year.
A jury convicted Drivas in April 2013 of health care fraud and health care fraud conspiracy, in a health care fraud scheme in which twelve others already have been convicted or pleaded guilty. According to the DOJ, Drivas knowingly allowed co-conspirators at a medical clinic in Brooklyn to use his Medicare billing number to submit over $20 million in false claims to Medicare for procedures that were never performed. In exchange, Drivas was paid over half a million dollars.
Between 2005 and 2010, Drivas ostensibly worked at a Brooklyn clinic with three corporate names: SVS Wellcare Medical PLLC, Bay Medical Care PC and SZS Medical Care PLLC. The clinic used all three names for submitting phony claims to Medicare. In reality, Drivas was little more than a “no show” physician who stopped by the clinic only to collect his checks.
The clinic made kickback payments to Medicare beneficiaries whose names were used to submit phony claims to for medical services that were neither needed nor provided. Between April and June 2010, Drivas’ co-conspirators were captured on video in a room at the clinic, making $500,000 in cash kickbacks to the clinic’s purported patients. Marked as private, the room contained a poster showing the image of a woman with a finger placed over her lips and a caption in Russian: “Don’t Gossip.”
Health Care Employees Help Defend Against Fraud
False Claims Act violations involving phony claims for nonexistent services frequently are exposed by health care employees. Informants willing to collaborate with the DOJ should learn how the process works before moving forward. The qui tam lawyers with Waters & Kraus provide tipsters with the legal representation they deserve. Contact us by email or call our False Claims Act attorneys at 855.784.0268 to learn more about our whistleblower practice.