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US Renal Care to Pay $7.3 Million Medicare Fraud Settlement Stemming From Whistleblower Case Alleging Drug Overbilling

The US Justice Department says that US Renal Care will pay $7.3 million to settle allegations that its Dialysis Corporation of America submitted false Medicare claims, billing more for Epogen, an anemia medication, than what it actually gave to dialysis patients. The accusations stem from a Qui Tam lawsuit filed by whistleblower Laura Davis.

DCA, which has over 100 outpatient dialysis clinics, is accused of billing Medicare not only for the amount of Epogen used by patients but also for the overfill that was left in the vials. The company purportedly didn’t do anything to use this excess and there was even a time when reimbursement for Epogen purportedly made up over 25% of the company’s revenue for medical services.

Davis, a nurse who worked at a DCA clinic, filed her whistleblower lawsuit in 2008. She claims that she first reported the billing discrepancies to the company but that no one paid attention to her. Under the False Claims Act’s qui tam provisions, Davis is entitled to a percentage of the multimillion-dollar recovery. The DOJ says that she will receive $1,314,000.

Examples or Medicare billing fraud:
• Billing for medical services never provided • Conducting medical tests the patient needs and billing Medicare for them • Billing twice for the same equipment or services • Upcoding: billing for a more expensive service than what was actually provided to a patient • Unbundling: Billing separately for certain services that are typically done together and can be billed collectively and at less of a cost
Massachusetts False Claims Act
The state has its own False Claims Act that offers whistleblowers financial incentives for reporting fraud. Recently, certain amendments were made to the Act to further encourage people to come forward and report fraud abuse. For example, now a court can no longer eliminate or lower the percentage a successful whistleblower can get. Also, a whistleblower now doesn’t have to be the “original” source of the fraud information. Additional information to the knowledge that is already in the public domain will suffice.

U.S. Renal Care to Pay $7.3 Million to Resolve False Claims Act Allegations, DOJ, May 21, 2013
Update: Whistleblower allegations about Medicare fraud led to $7.3 million settlement, The Dallas Morning News, May 22, 2013

More Blog Posts:
Nursing Home to Pay $2.7M for Medicaid Fraud Claims Brought to Light By Whistleblower, Boston Injury Lawyer Blog, March 23, 2013
Generic Drug Manufacturer Ranbaxy Will Pay $500M To Settle in False Claims Act and Whistleblower Allegations Involving Medicaid/Medicare Fraud & Pharmaceutical Fraud, Drug Injury Lawyer Blog, May 14, 2013
You want to work with an experienced Boston whistleblower law firm that can work with you from the time you decide to report the Massachusetts Medicare fraud until you get your recovery.