Whistleblower Complaint Leads to $22.5 Million False Claims Act Settlement

June 2, 2021

Here’s 22.5 million reasons why you should consult with a whistleblower law firm if you’re aware of any Medicare Fraud or Medicaid Fraud. A whistleblower has once again proven the importance of vigilance. This whistleblower’s courage led to a $22.5 million civil settlement to resolve allegations of Medicare fraud and Medicaid fraud in violation of the False Claims Act.

Doctors Care, P.A. (hereinafter known as Doctors Care), is South Carolina’s largest urgent care provider network. Its management company is UCI Medical Affiliates of South Carolina, Inc., (hereinafter called UCI). The whistleblower complaint alleged that Doctors Care and UCI falsely certified that certain urgent care visits were performed by providers who were credentialed to bill Medicare, Medicaid, and TRICARE for medical services, when in fact these providers did not have such credentials.

Federal health insurance companies require healthcare providers to apply for and receive credentials before they are allowed to bill any services to the insurer. This requirement applies to doctors and mid-level providers like nurse practitioner.

It was alleged that as early as 2013, Doctors Care and UCI were unable to secure the required billing credentials for most of their providers. Instead of fixing the problem, they continued to falsely claim that their medical providers were allowed to bill and submit their billing credentials to specific insurers.

A whistleblower’s report against Doctors Care and UCI led to a three-year investigation, culminating in a $22.5 million settlement. Special Agent Christopher Dillard of the DCIS Mid-Atlantic Field Office said that “The results of this investigation exemplify the commitment of the United States Department of Defense Criminal Investigative Service and its law enforcement partners to root out fraud and corruption involving unscrupulous companies that undermine the integrity of the Department of Defense. This case should serve as a stark warning to those who attempt to exploit Department of Defense resources for personal gain.”

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Noted whistleblower lawyer and former FBI Special Agent Jason T. Brown commented, “More fine work performed by the hand in fist cooperation between whistleblowers and the government under the False Claims Act.  This case was not from our firm, but outstanding work and the whistleblower stands to receive a whistleblower award of four to five million for doing the right thing.  Great job.”

In addition to the monetary settlement, Doctors Care and UCI entered into a Corporate Integrity Agreement with the Office of Inspector General. 

Employees who have information about systemic wrongdoings leading to Medicare, Medicaid and TRICARE fraud and abuse, should take advantage of a free, confidential consultations with top whistleblower law firm Brown, LLC to learn how to approach the government the RIGHT way. Our whistleblower lawyers are led by a Former FBI Special Agent and Legal Advisor.  If you’re thinking about blowing the whistle, you should call (877) 561-0000 to learn your rights as a whistleblower and speak with a whistleblower law firm with results all over the country – before someone blows the whistle before your do.