Recent Whistleblower Case Settlements & Whistleblower Awards

November 28, 2023

Significant DOJ False Claims Act Enforcement Actions in 2023

So far in 2023, the Department of Justice (DOJ) has made public at least 36 False Claims Act (FCA) settlements, amounting to over $485 million in recovery, and an outsized roughly 10% of those recoveries are from the storied whistleblower law firm Brown, LLC.

Famous whistleblower cases have brought to light corruption and misconduct in a variety of industries, frequently resulting in significant changes and reforms. Whistleblowers seeking Medicare whistleblower rewards play an important role in exposing healthcare fraud and holding offenders accountable. Many people turn to the best whistleblower law firms like Brown, LLC to ensure their legal protection and increase their chances of winning a case. These firms specialize in defending whistleblowers’ rights.

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In the subsequent sections, we provide an overview of the most notable and famous whistleblower cases and settlements from 2023 to date with a focus on the principal theories of liability relevant to these resolutions. As is customary, healthcare and life sciences sectors continued to feature prominently in the landscape of FCA recoveries, both in terms of quantity and financial value. Nevertheless, the DOJ also announced significant resolutions in the realm of government contracting and procurement whistleblowers.

  • On January 9th, a consortium of physicians agreed to pay approximately $1.85 million to settle allegations of False Claims Act (FCA) violations pertaining to the group’s billing Medicare and Medicaid for medically unnecessary cataract surgeries and diagnostic tests, some of which were incomplete and/or lacked value. Additionally, they were accused of billing for office visits where the level of service claimed was not provided, which is known as upcoding. As part of the settlement, the physicians’ group entered into a comprehensive five-year Integrity Agreement and Conditional Exclusion Release with the Office of Inspector General for the Department of Health and Human Services (HHS-OIG). HHS-OIG. This settlement stemmed from a qui tam lawsuit under the False Claims Act brought by a former employee which under the statute the insider was eligible for up to $555,000 in whistleblower rewards
  • On February 7, a clinical laboratory services provider reached an agreement to pay $19 million in order to settle allegations of False Claims Act (FCA) violations, relating to the submission of false claims to Medicare. The government’s assertions were based on the company’s allegedly engaging in a kickback scheme contrary to the Anti-Kickback Statute (AKS) by providing phlebotomy services to physicians who, in turn, ordered laboratory testing from the company. through “third parties” It was claimed that the company was aware of these third-party providers making payments to the doctors as incentives for referrals and those parties already settled allegations for $48.5 million This settlement emerged as a result of a qui tam lawsuit initiated by two relators under the False Claims Act. In recognition of their contributions, the relators collectively received an approximate sum of $5.6 million in whistleblower awards from the settlement. 
  • On February 27, a Pennsylvania physician, a university medical center, and a healthcare practice collectively agreed to pay a total sum of $8.5 million,resolving allegations of improper billing related to concurrent surgeries. The government’s claims focused on the physician’s regular practice of simultaneously conducting multiple complex surgical procedures, during which it was alleged that the physician failed to actively participate in all the “key and critical” aspects of these surgeries. This led to patients enduring extended and medically unnecessary periods of anesthesia, as the physician transitioned between procedures. The settlement also necessitates the implementation of a corrective action plan for the physician, alongside a third-party audit of the physician’s Medicare billings. As part of this resolution, the university medical center retains the ability to seek guidance and/or an advisory opinion from the Centers for Medicare and Medicaid Services (CMS) regarding specific Medicare regulations pertaining to surgical practices.
  • On March 3, a medical center in Florida entered into an agreement to pay $4 million in order to settle allegations related to the improper funding of Florida’s portion of specific Medicaid payments. The allegations centered on the medical center’s practice of making donations to a local governmental entity, which were subsequently returned to the medical center as Medicaid reimbursements. The government contended that during the period between October 2014 and September 2015, the medical center, under the guise of a donation, took on and covered the Medicaid contribution obligations of the local government unit. These donations were purportedly designed to bolster Medicaid payments received by the medical center by enabling the local government unit to allocate funds as part of the state’s share of Medicaid payments to the medical center. Under the False Claims Act settlement structure, the whistleblower, if any, would have been entitled to up to a $1.2 million whistleblower reward.

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  • On April 19, a healthcare company based in Virginia reached an agreement to pay $3 million, resolving allegations of False Claims Act (FCA) violations stemming from fraudulent billing practices in connection with pediatric in-home health, personal care, and related services. The allegations encompassed billing Virginia Medicaid for in-home healthcare services designated for pediatric patients who, were, in actuality, were already hospitalized, during the billed period. Additionally, the company was accused of billing for home health services that were never actually provided, commonly referred to as billing for services not rendered This settlement also addresses claims brought forth by a qui tam relator who under the False Claims Act settlement framework would be entitled to up to a $900,000 whistleblower award.
  • On May 25, a vascular surgeon reached an agreement to pay a sum of up to $43.42 million to resolve allegations that his fraudulent billing practices within healthcare programs constituted a breach of the False Claims Act (FCA). The government’s claims centered on the surgeon’s submission of false claims for medical procedures that were never actually conducted and his improper utilization of Modifier 59 to “unbundle” services that should have been combined and billed as a single claim. In a parallel criminal case, the surgeon received a sentence of 80 months in prison and was mandated to pay restitution totaling $19.5 million. The FCA settlement emerged as a resolution of a qui tam lawsuit, and the relator involved in the case stands to receive a share of up to $4,341,900 in False Claims Act whistleblower rewards from the recovery. 
  • On June 15, two pharmacies located in Jacksonville came to an agreement to pay $7.4 million, with potential additional contingency amounts, in order to resolve allegations that they engaged in deceptive practices. These practices included the addition of an antipsychotic drug to topical pain creams to increase reimbursement, as well as routinely waiving patient copayments for Medicaid and Medicare patients. As part of the settlement, the owner of the pharmacies entered into a comprehensive three-year integrity agreement with the Department of Health and Human Services Office of Inspector General (HHS-OIG. This settlement effectively resolved two qui tam lawsuits initiated by two former employees, who could be entitled to more than $2.22 million in whistleblower awards.
  • On October 2, Genomic Health, Inc. (GHI), a Delaware corporation based in Redwood City, California, agreed to a $32.5 million settlement to resolve allegations of False Claims Act violations related to a nationwide scheme involving improper Medicare billing for specific cancer diagnostic tests. GHI, a subsidiary of Exact Sciences Corporation, was accused of evading Medicare’s 14-Day Rule, which regulates the billing of genomic laboratory tests such as the Oncotype DX® tests. The alleged misconduct encompassed seeking direct reimbursement from Medicare for tests ordered within 14 days after inpatient discharges or outpatient procedures, conspiring with healthcare providers to manipulate test orders, and failing to send timely invoices to hospitals for services subject to the 14-Day Rule. As part of the settlement, GHI agreed to pay $32.5 million to compensate for losses resulting from these false claims. The settlement stemmed from two qui tam actions under the False Claims Act, with the relator’s share totaling $5,687,500 as whistleblower awards The first to file relator was represented by the whistleblower law firm Brown, LLC. 

Whistleblowers play a vital role in upholding ethics and accountability, often relying on the expertise of the best whistleblower law firms to navigate the legal complexities of their cases. The stories of famous whistleblowers serve as inspiring examples of individuals who were willing to risk their careers to expose wrongdoing. Medicare whistleblower rewards incentivize those with inside knowledge to come forward and report fraud within the healthcare industry. These famous whistleblower cases have underscored the importance of a whistleblower’s willingness to stand up against powerful entities to ensure justice and fairness prevail.