The United States government suffers an astronomical loss in the billions each year due to fraud in the healthcare industry. Doctors, laboratories, and many healthcare facilities commit fraud in many different ways. When misconduct occurs in these facilities and the patient is insured through a governmental program, such as Medicare or Medicaid, then it means money is being stolen from the U.S. government.

Early in 2018, a judge in South Carolina entered a judgment  that totaled $114 after three whistleblower cases were investigated. A number of health care facilities and doctors were linked to the case, all of whom were held responsible for the fraud they had committed. The evidence in regards to the fraudulent activity was brought forward by employees of these facilities.

Whistleblower Cases Against Health Care Facilities In South Carolina

After three whistleblower cases were filed this year, a South Carolina judge entered a judgment against them for $114M, payable by the healthcare institutes that were involved in the Qui Tam cases. This judgment was made after a jury at Charleston, SC, found the defendants in the case guilty for defrauding Medicare, a health care program that is funded by the government.

Three Qui Tam cases were filed, and the litigation of the three cases was conducted together. Only one of the whistleblowers involved in these cases testified in the courtroom.  Evidence was made available that proved these companies were paying certain physicians to order blood tests from the laboratories that were completely unnecessary. These drug tests yielded large fees, which were claimed from the federally funded insurance program of the patient. The physicians who participated in the fraud were instructed only to seek out patients who were insured by Medicaid or a similar healthcare agency.

In many cases, some expensive blood tests were ordered for cardiovascular diseases that the patient did not have. The doctor was, in turn, paid a $20 fee for ordering these tests. The pay to play or kickback scenario sometimes triggers violations of the Anti-Kickback statutes or if there is self-dealing the Stark Act.

The investigation found that Health Diagnostic Laboratory had submitted a total of 35,074 claims to government health care programs. Another 3,813 claims linked to these frauds were submitted by Singulex, a blood laboratory based in California.

Conclusion

Whistleblowers play an important role in the recovery of money lost by the government due to fraud in the healthcare industry. The case against Quest Lab, Singulex, and the Health Diagnostic Laboratory allowed the government of the United States to recover $114M in losses caused by fraudulent activities from these institutes. While no specific data was released regarding the awards issued to the whistleblowers, the reward amount was likely between $17.1M and $34.2M, divided between the employees who brought up the Qui Tam lawsuits. If you know of any healthcare fraud, Medicare Fraud, Medicaid Fraud or anyone else defrauding the government you should speak with a whistleblower law firm like Brown, LLC who offers free consultations and can advice you on your rights.

South Carolina Judge Enters Judgment for $114M in Favor of Whistleblowers