The U.S. Attorney’s Office for the Middle District of Florida announced on February 13 that Florida Cardiology, P.A., and a number of physicians will pay the U.S. and Florida $2 million to resolve allegations that they violated the False Claims Act. The qui tam whistleblowers, Derrick Graham and Jesse Frauenhofer, will receive a $420,000 award as part of the settlement.
The qui tam provisions of the False Claims Act enable private citizens to file lawsuits on behalf of the government if they know of an individual or company defrauding the government. Qui tam whistleblowers are eligible to receive between 15 and 30% of the government’s recovery, if one occurs.
According to the press release, the U.S. and the State of Florida “intervened in a whistleblower lawsuit against Florida Cardiology and the physician-defendants on June 27, 2022. The lawsuit and settlement relate to the submission of claims that were improperly billed or performed, and submitted or caused to be submitted by Florida Cardiology, Sandeep Bajaj, Abbas Ali, Karan Reddy, Claudio Manubens, Milan Kothari, Saroj Tampira, Sayed Hussain, Raviprasad Subraya, Harish Patil, and Edwin Martinez.”
For this case, Drs. Bajaj and Reddy allegedly “caused Florida Cardiology to bill for more intravascular stents than were actually inserted into patients.” The press release explains that allegedly, “Dr. Bajaj caused Florida Cardiology to bill for radiofrequency ablations that were not performed by him and in some instances, were not performed by a qualifying provider; and all ten physician-defendants caused Florida Cardiology to bill for procedures and services while they were outside the United States.”
The settlement agreement states that “Florida Cardiology submitted these false claims for payment to Medicare, Medicaid, TRICARE, and the Federal Employee Health Benefits Program.” According to the press release, this settlement concludes the lawsuit that whistleblowers Graham and Frauenhofer originally brought.
Florida Attorney General Ashley Moody pointed to the whistleblowers’ contributions to the case, stating: “The defendants in this case attempted to rip off taxpayers—even going as far as billing Medicaid and Medicare for services they claimed were provided to patients in Florida while these doctors were actually out of the country. As a result of their brazen scheme and the great work of whistleblowers, my Medicaid Fraud Control Unit and our federal partners, these defendants will now pay for ripping off taxpayers.”
Health care fraud is one area in which the False Claims Act has been especially effective: in Fiscal Year 2022, “[s]ettlements and judgments under the False Claims Act exceeded $2.2 billion,” according to prior WNN reporting. Of that $2.2 billion, “over $1.7 billion related to matters that involved the health care industry, including drug and medical device manufacturers, durable medical equipment, home health and managed care providers, hospitals, pharmacies, hospice organizations, and physicians.” Health care fraud and schemes often harm the most vulnerable citizens and can erode trust in the medical system, so whistleblowers play a critical role in exposing this wrongdoing and saving taxpayers and patients money.