Baldwin Bone & Joint P.C. is an orthopedic surgery and physical therapy practice in Alabama. The southern medical practice has three locations in Bay Minette, Orange Beach and Daphne. They see hundreds of patients, many of which use Medicare or Tricare.
Recently, the physical therapy practice was at the center of a civil lawsuit. The whistleblower lawsuit was filed against Baldwin Bone & Joint P.C. (BB&J) for allegedly billing for unnecessary medical services and paying kickbacks.
After mediation with the United States government and the whistleblower, BB&J agreed to a $1.2 million settlement for improper billing practices and fraudulently collecting reimbursements from Medicare and Tricare.
UNDERSTANDING THE CASE
The civil lawsuit was filed in the Southern District of Alabama by John Seddon, a former employee of BB&J. The lawsuit (the United States, ex rel. John Seddon, v. Baldwin Bone & Joint) was filed under the qui tam provisions of the False Claims Act. This Act gives private individuals protection and rewards for filing false claims lawsuits on behalf of the government.
Whistleblower John Seddon initiated the federal investigation after working at Baldwin Bone & Joint, P.C., for several years. According to the lawsuit, BB&J violated the False Claims Act by falsely billing Medicare and Tricare for physical therapy services performed by unqualified and unauthorized providers. This included Seddon.
Seddon was employed by BB&J as an exercise physiologist. Court documents showed that athletic trainers and exercise physiologists like Seddon were required to perform the duties the physical therapists were supposed to do. The therapists would then sign the forms and submit them for billing. This constitutes Medicare fraud, and it is against the law.
In addition to Medicare fraud, there were allegations that BB&J violated the Physician Self-Referral Law, also known as the Stark Law. The lawsuit alleged that BB&J directly compensated shareholder physicians by giving them kickbacks for referrals. This is in direct violation of the Stark Law.
MEDICARE FRAUD HURTS ALL OF US
While no patients were harmed in this case, Medicare fraud hurts us all. False claims against taxpayer-funded programs hurt and destroy the entire healthcare system in the country. When physicians improperly bill Medicare for false services or inaccurate services, this constitutes Medicare fraud. Everyone who depends on Medicare funding is harmed when physicians fraudulently deceive the government.
Improper billing, upcoding for services, and false patient billing are all examples of Medicare fraud. Medicare fraud costs our healthcare system more than $47 billion.
If you have evidence of Medicare fraud, you may be able to collect a substantial reward for blowing the whistle on this illegal activity. Whistleblowers are protected by law and provide a valuable service to the U.S. government.
HOW THIS CASE IMPACTS FUTURE CASES
This case highlights the U.S. Attorney’s Office’s commitment to investigate allegations of Medicare fraud and abuse. These allegations and reports are not taken lightly, and whistleblowers with evidence of fraud are rewarded for their service. The False Claims Act protects whistleblowers who expose fraud, corruption, and deception that harms the U.S. government or consumers.
Future whistleblower cases may find an easier path when exposing Medicare fraud, such as billing for unnecessary services, kickbacks, and other violations.
CONTACT OUR MEDICAL BILLING FRAUD ATTORNEYS TODAY
At Price Armstrong, we have extensive experience litigating Medicare fraud cases under the False Claims Act. Whistleblowers are critical to stopping unethical medical billing practices. We protect whistleblowers every step of the way and help maximize their recovery. Contact us today for a free initial consultation and review of your case.
