On March 22, U.S. Attorney Alamdar S. Hamdani of the Southern District of Texas announced that a physician based in Houston agreed to pay $1.8 million to settle alleged violations of the False Claims Act (FCA).
The allegations were brought forward by a qui tam complaint filed by multiple whistleblowers, who alleged that the physician, Dr. Mohammad Athari, had falsely submitted claims to Medicare and Medicaid. According to the DOJ’s press release, these “claims were for services that were not reasonable or medically necessary.”
Not only was the whistleblowers’ information key for resolving alleged misuse of Medicare Part B between 2014 and 2017, but they also assisted the settlement of “false claims to Medicare by billing for diagnostic imaging procedures” from 2014 to 2021. These acts went against the Stark Law, or the Physician Self-Referral Law.
“The Stark Law was enacted to ensure that a physician’s clinical judgment is not corrupted by improper financial incentive,” stated Hamdani. “Similarly, physicians that bill government healthcare programs must ensure they are billing for medically necessary services and not just maximizing their own income.”
Special Agent in Charge Jason E. Meadows with the Department of Health and Human Services-Office of Inspector General (DHHS-OIG) asserted that the “DHHS-OIG remains steadfast in holding accountable those who prioritize personal gain over delivering legitimate medical services.”
The qui tam provisions of the FCA allow whistleblowers to file lawsuits on behalf of the U.S. government and receive between 15 and 30% of the recovered funds. In this case, the whistleblowers will receive 18% of the settlement. With the help of False Claims Act and qui tam attorneys, private citizens (including those living in foreign countries) have the power to blow the whistle on large-scale fraud cases. These provisions incentivize whistleblowers, or “relators,” to provide the government with evidence related to large fraud cases.
The False Claims Amendments Act of 2023, a bipartisan effort introduced on July 25, seeks to correct a few technical loopholes used to circumvent the FCA. The bill is widely supported by whistleblower advocates. One such advocate, attorney Stephen M. Kohn argues that “These amendments are urgently needed to ensure that whistleblowers can continue to play their key role in protecting taxpayers from corporate criminals.”
Kohn sees the passage of the False Claims Amendments Act as one of the seven most urgently needed whistleblower reforms. National Whistleblower Center (NWC), where Kohn serves as Chairman of the Board, has issued an Action Alert calling on Congress to pass the bill.
Join NWC in Taking Action:
Demand that Congress strengthen the False Claims Act
Further Reading:
Physician pays $1.8M to settle False Claims Act liability
Bipartisan Legislation Unveiled to Strengthen False Claims Act