Skin Surgery Whistleblower Represented by Price Armstrong Helps Recover Over $800,000 From Dermatology Group
When dermatologists fraudulently inflate their bills to Medicare for wound care, skin grafts, or even skin surgery, the Government needs whistleblowers willing to come forward and put an end to it. We represented a client in a qui tam case that alleged that a dermatology practice was fraudulently billing Medicare for complicated skin flap surgeries when the actual surgeries were simpler.
We teamed with the Federal government and got the Defendants to pay $847,394 to avoid going to trial and resolve allegations that they violated the False Claims Act by knowingly causing the submission of falsely coded claims to Medicare for wound repair procedures. Both the defendant practice and surgery center performed wound repair procedures following Mohs micrographic surgery, a method of skin cancer removal.
Our client alleged that his employer caused the submission of false claims to Medicare by using inaccurate wound repair billing codes for which Medicare paid more money than it would have paid for the wound repairs that were actually performed — a practice known as “upcoding.” Specifically, Defendants falsely coded linear repairs as if they were flap repairs and falsely coded smaller flap repairs as if they were larger flap repairs.
“Improperly billing Medicare depletes valuable government resources that provide necessary medical care to millions of Americans,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “We will hold accountable health care providers who enrich themselves by defrauding federal health care programs.”
“This office will continue to aggressively root out fraud, waste, and abuse in our healthcare system by pursuing providers who submit false claims to Medicare,” said U.S. Attorney John P. Heekin for the Northern District of Florida. “We will hold those who attempt to defraud the federal government accountable to the fullest extent of the law.”
“Schemes that cause Medicare to pay for costlier services than were actually performed waste taxpayer funding, threatening the integrity of this federal health care program,” said Deputy Inspector General for Investigations Christian J. Schrank of the U.S. Health and Human Services Office of Inspector General (HHS-OIG). “Working together with our law enforcement partners, HHS-OIG will continue to investigate allegations of improper billing schemes to protect taxpayer-funded health care programs and the people served by them.”
The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by our client, a former employee. Under those provisions, a private party (a “Relator”) can file an action on behalf of the United States and receive a portion of any recovery. The Relator award was $152,531 in connection with the settlement.
If you work for a dermatology or other physician practice and believe your employer is defrauding the government, Price Armstrong can help you evaluate your case, file a confidential claim, and fight for justice on your behalf.
