Individuals who witness physicians, physician groups and hospitals billing for services and products that were not provided are started to speak up. Qui tam actions permit individuals to file a civil suit, under seal, for filing false claims. Often these actions are filed in federal court because they may involve reimbursement issues related to Medicare and Medicaid recipients. The goal, in part, is to encourage the disclosure of actions that cost the federal government money it is not legally responsible for paying.
Sometimes, healthcare providers may be accused of receiving illegal kickbacks – money paid in exchange for unlawful favoritism. A California lawsuit accuses two surgeons and four hospitals in Las Vegas of participating in a massive health care fraud scheme that involved implanting counterfeit spinal hardware into unsuspecting patients. The case, filed in February by dozens of insurance companies in Los Angeles County Superior Court, was recently unsealed.
According to the lawsuit, California-based Spinal Solutions and others knowingly manufactured fake hardware “at a fraction of the cost when compared with genuine product, and insidiously co-mingled fake implantable hardware with genuine product to make it difficult to trace.” They also paid kickbacks to surgeons to use the product as part of the scheme to present false billing statements and invoices to insurance companies for reimbursement, according to the lawsuit.
The alleged scheme may involve surgeons in Texas, Wisconsin and Maryland. The suit alleges that the defendants entered into a sham design and development agreement with Spinal Solutions that called for the company or its president, Roger Williams, to pay them unlawful kickbacks for implanting the counterfeit hardware into unwitting patients.