The U.S. Department of Justice (DOJ) announced on September 7 that Dr. Ronald Bergman and his medical practice Bergman Cosmetic Surgery, P.C. will pay $800,000 to settle allegations that they violated the False Claims Act. The case stemmed from a qui tam, or whistleblower, complaint.
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. In this case, the U.S. government intervened in the whistleblower’s case and conducted the investigation.
According to the press release, the U.S. government “alleged that from 2013 to 2020, Bergman submitted inappropriate claims for payment to government healthcare programs in three ways.” Below is a breakdown of the ways in which Bergman submitted inappropriate claims:
- Allegedly, Dr. Bergman “submitted claims to Medicare and Medicaid in his own name when, in fact, the services were rendered by auxiliary personnel, and when there was insufficient physician involvement for the claims to be billed in Bergman’s name.”
- The government alleged that similarly, Dr. Bergman “submitted claims to Medicare and Medicaid in his own name when, in fact, the services were rendered by medical fellows without Bergman, as the teaching physician, being physically present.”
- Thirdly, the U.S. alleged “that Bergman submitted claims to Medicare for medically unnecessary and unreasonable applications of skin substitute products.”
The press release states that the qui tam whistleblower “will share in the United States’ financial recovery” but does not disclose any additional information.
Whistleblowers are key to uncovering corruption and misconduct in the healthcare industry: fraudulent schemes can be particularly harmful to patients and erode trust in the medical system. In Fiscal Year 2021, qui tam whistleblowers helped the DOJ recover $1.6 billion in settlements. The DOJ highlighted health care fraud as “the leading source of the department’s False Claims Act settlements and judgments.”