On August 24, the U.S. Attorney’s Office for the Eastern District of Michigan announced that a Michigan interventional pain management specialist, Rajendra Bothra, M.D., and two medical entities that he owned and operated had agreed to pay $6.5 million to resolve claims they had violated the False Claims Act (FCA).
In connection with the case, two whistleblowers filed separate civil suits under the qui tam provision of the FCA. Qui tam claims 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. According to the settlement, the whistleblowers will receive $1,267,500 in total.
According to the Attorney’s Office, Bothra and his companies “billed Medicare and Medicaid for excessive and medically unnecessary presumptive and definitive urine drug tests that were not relevant to their patients’ diagnosis or treatment, along with additional laboratory charges that were not separately billable with the urine drug tests.”
“Additionally, Defendants are alleged to have billed Medicare and Medicaid for medically unnecessary moderate sedation services that were routinely performed in conjunction with interventional pain management procedures that did not require moderate sedation services,” the press release further states. “The government also alleges that Defendants frequently charged Medicare and Medicaid for expensive back braces that were medically unnecessary or otherwise ineligible for reimbursement.”
“This settlement underscores the important role that medical providers have in ensuring that the claims submitted to Federal health care programs are medically necessary,” said Mario M. Pinto, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General. “Our office remains committed to working with our law enforcement partners to ensure that health care providers who violate the False Claims Act are held accountable.”
“When healthcare providers manipulate the Medicaid and Medicare systems, it wastes resources meant to help those in need,” said Devin J. Kowalski, Acting Special Agent in Charge of the FBI’s Detroit Field Office. “This settlement brings to bear some economic justice by requiring those who orchestrated the fraud scheme to pay for their actions.”
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.”