The US Department of Justice continued its pursuit of health care fraudsters by joining a qui tam whistleblower lawsuit against a California radiology company that allegedly submitted faulty Medicare claims.
The DOJ joined portions of a qui tam lawsuit filed against William M. Kelly, M.D. Inc., and Omega Imaging Inc., according to a DOJ press release. Syd Ackerman filed the original suit in 2013, a former consultant to the company, who claims that Omega violated the False Claims Act by billing Medicare for services that didn’t satisfy claim rules.
Under Medicare rules, a physician must be present during the performance of radiology procedures such as CT and MRI scans. The rules also require the accreditation by state or independent accreditation agencies of the Medical facilities. According to the original complaint, Omega allegedly billed Medicare for services performed without a physician present and at unaccredited clinics. Omega operates 11 clinics in Southern California.
According to the DOJ, one of the most powerful tools in combating health care fraud is the False Claims Act. The False Claims Act contains qui tam whistleblower provisions that allow individuals to sue on behalf of the government. Whistleblowers are eligible to collect 15 to 30 percent of any penalties collected by the government as a result of a prosecution that succeeds based on information provided by the whistleblower. These penalties are often significant since fraudsters are liable for civil sanctions as well as treble damages.
Health care fraud is a significant focus of the DOJ, and whistleblowers play a major role, particularly involving fraudulent Medicare claims. Individuals with information about potential fraud, waste, abuse, and mismanagement should contact a whistleblower attorney to learn about their rights under the current whistleblower reward laws.