US v. Dr. R (DMC No. 17107) – Federal Medicare Billing Fraud ($7,971,134) per the False Claims Act & Qui Tam, and a Lincoln Law Civil Suit – Not Charged (and Instead Pursued with a Civil Lawsuit) – United States District Court, District of Arizona (Case No. 2:XX-CV-XXXXX-XXF)
Dr. R was in a partnership with a large-scale Oncology Clinic that provided services for thousands of people a year. The Clinic’s billing manager was doing a poor job, and had become disgruntled. He contacted a Law Firm that advertised nationwide for “Whistleblower and Lincoln Law” representation. What this means is if a “Whistleblower” who is an employee of a company that is accused of committing Federal Medical Billing Fraud, they can be paid anywhere from 10 to 40% of the recovery in a Criminal or a Civil Action. Also, once a Whistleblower comes forward, the employer must keep the employee, and cannot fire them as a retaliatory action. All in all, it is a very mercenary law that is disliked by the general public and Lawyers alike.
The Lawyers for the Whistleblower claim that Dr. R and his partners were billing the State with a large amount of certain Medicare billing codes. What they failed to realize is that they also were treating the most people in the State (by far), so that would naturally mean they were billing the most of any Clinic (by far). Specifically, the allegations were that they were using a medical code reimbursement of 77290 for five years which totaled $4,540,000. They also claimed that a separate code of 77470 resulted in total billings of $2,430,000. A third code of 77427 totaled $134,000. Lastly, they claimed that any second CT scan being conducted during cancer treatments was inappropriate, and that totaled $1,482,000 of billing. The grand total billing amount between all of these charges over a five-year timespan was $7,971,134.
When these allegations first came forward, DM Cantor stepped in to make sure that Dr. R was not going to be Charged by the United States Attorney’s Office. Once we presented all evidence that these billing charges were normal (and Not Criminal), and that due to their large volume the numbers seemed to be high. In reality, if you looked at each individual patient, there was really nothing out of the ordinary. Although we prevented from any Criminal Charges from being filed against Dr. R, the Civil suit went forward. We were able to get Dr. R set up with another Law Firm’s Civil Attorneys who we had worked with in the past regarding Qui Tam/False Claims Act cases. They were ultimately able to get the case settled for a minimal amount of money.
