Two men have filed a whistleblower case in what may be one of the largest incidents of Medicare fraud in the country’s history. The plaintiffs are Dr. Alon Vainer, a dialysis clinics medical director, and nurse Daniel Barbir. They contend that their employer, dialysis company DaVita Inc., overbilled Medicaid and Medicare by hundreds of millions of dollars between 2003 and 2010 for the purpose of making a profit.
According to Vainer and Barbir, the Medicare/Medicaid billing fraud took place at over 1,800 clinics that treated tens of thousands of patients. Per CNN, Vainer said that for example, with the drug Venofor only part of a 100 milligram vial would be administered to a patient, while the rest of it would be disposed of (while the company billed the government based on use of the entire vial) and the same would be done with other100-milligram vials of Venofor. The more vials that were used, the more money DaVita was able to make off its alleged scam.
Barbir and Vainer claim that they attempted to get this practice stopped but were told to back off and keep following protocols. Barbir eventually left the company while Vainer, who stayed on, said his medical directorship wasn’t renewed as punishment.
DaVita is denying wrongdoing and intends to fight the allegations in court. However, the dialysis company also just settled similar accusations for $55 million. That Medicare fraud lawsuit, also based on a whistleblower claim, accused DaVita of overusing Emogen, an Amgen-manufactured anemia drug. The whistleblower claimed that DaVita would double-bill the government for portions of the drug that hadn’t been used.
Medicare Billing Fraud
Unfortunately, Massachusetts Medicare billing fraud continues to cost the government and US taxpayers every year while those involved in this type of scam make a profit. Double billing, billing for medical services and products that were never provided, upcoding, conducting tests and procedures that aren’t needed, unbundling, and medical equipment fraud are some of the more common types of Medicare billing fraud.
The False Claims Act’s qui tam provision lets private citizens that know of Medicare billing fraud and step forward to report such wrongdoing. Should they file a whistleblower/qui tam lawsuit, they may even be entitled to part of what is recovered on the government’s behalf.
Dialysis company accused of giant Medicare fraud, CNN, November 30, 2012
Denver-based DaVita settles case on overuse of kidney care drug, The Denver Post, July 4, 2012
More Blog Posts:
Whistleblower Accuses Planned Parenthood Affiliate of Submitting $5.7M in Fraudulent Medicaid Claims, Boston Injury Lawyer Blog, May 31, 2012
$25M Whistleblower Settlement Reached in Hospice Fraud Case Against Odyssey Healthcare Inc., Boston Injury Lawyer Blog, March 25, 2012
Pharmaceutical Fraud: GlaxoSmithKline Enters Guilty Plea to Allegations It Marketed Wellbutrin and Paxil for Unapproved Uses and Didn’t Report Avandia Clinical Data; Will Pay $3B, Forfeit $43 million, Boston Injury Lawyer Blog, July 3, 2012