Qui Tam Whistleblowers Awarded for Exposing Alleged Upcoding Scheme


On November 6, the U.S. Attorneys for the Northern District of Georgia announced that a physician based in Snellville, Georgia agreed to pay $225,000 to resolve allegations that they violated the False Claims Act (FCA) through improper billing. The case was initiated by a qui tam whistleblower lawsuit filed by former employees.

According to the government, “This settlement resolves allegations that from January 2, 2018, to February 12, 2021, Saima Syed knowingly submitted false claims to federal healthcare programs for office visits that were not as complex or lengthy as Saima Syed purported. This is a practice commonly known as ‘upcoding.’ The government also alleged that Saima Syed submitted claims of certain office visits to federal healthcare programs as though she had personally provided the service, even though she was travelling out of the country at the time these services were allegedly performed.”

“Physicians who attempt to unlawfully obtain funds from government healthcare programs by padding their bills siphon scarce resources from vital programs,” said U.S. Attorney Ryan K. Buchanan. “This settlement represents our office’s commitment to ensure accountability for physicians who place their greed over following the rules established by Medicare and Medicaid.”

The underlying qui tam lawsuit was filed by Herretta Pickens and Tahirah McCloud, former employees of the Syed Practice Group. The False Claims Act’s qui tam provisions allow 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.

On July 25, a bipartisan group of senators introduced the False Claims Amendments Act of 2023, which address a few technical loopholes undermining the success of the FCA. The bill is widely supported by whistleblower advocates.

“The False Claims Act is America’s number one fraud-fighting law,” said whistleblower attorney Stephen M. Kohn. “These amendments are urgently needed to ensure that whistleblowers can continue to play their key role in protecting taxpayers from corporate criminals.”

Further Reading:

Snellville doctor pays $225,000 to resolve allegations for improper billing

What is Upcoding?

Bipartisan Legislation Unveiled to Strengthen False Claims Act

More False Claims Act Whistleblower News

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