How Qui Tam Lawsuits Can Affect Florida’s Healthcare Providers
One of the more complicated types of civil lawsuits that you often see in Florida courts are qui tam actions. A qui tam lawsuit is a type of whistleblower claim under the False Claims Act (FCA). Basically, if someone has evidence that a person or company has violated the FCA–i.e., fraudulently obtained money from the government–this whistleblower can file a civil lawsuit “on behalf of” the government to recover that money. The government then has the option of taking over the case itself or allowing the whistleblower, known as a relator, to continue the case. If the FCA claim ultimately succeeds, the relator gates a percentage of the recovery.
Jacksonville Judge Allows Some FCA Claims Against Putnam Hospital to Proceed
Qui tam claims are frequently brought against healthcare providers accused of defrauding Medicare and Medicaid. For example, a federal court in Jacksonville recently allowed a qui tam case to proceed against Putnam County Medical Center (PCMC) in Palatka, Florida. Without deciding the merits, the judge found the relator’s complaint met the minimum requirements for stating a claim under the FCA and its Florida state counterpart.
According to the relator’s complaint, he worked for PCMC from 2013 to 2019, serving as manager of its Sleep Lab for the last four years. Essentially, the relator alleged his lab was closed and his position eliminated after he made multiple attempts to report PCMC’s failure to comply with Medicare regulations regarding diagnostic testing.
Medicare does not require a physician to be present during the performance of a diagnostic test. But such testing must be conducted under the “physician’s overall direction and control.” But the relator alleged that tests were routinely performed at the Sleep Lab with no physician supervision at all. This meant the tests themselves were not “reasonable and necessary” as defined by the Medicare regulations. So the government’s payment for said tests were effectively a form of billing fraud, according to the relator.
In response, PCMC argued that the relator misstated the correct standard regarding physician supervision and that there were no actual allegations of billing fraud. The judge, however, noted the relator did provide copies of what he alleged to be “representative claims” submitted by PCMC and paid by Medicare. This may not ultimately prove an FCA violation, but it was sufficient for his case to survive PCMC’s motion to dismiss the complaint.
That said, the court did dismiss certain claims related by the relator with respect to “downstream” providers. That is to say, the judge held that the relator could not pursue FCA claims based on allegations that other providers who relied on PCMC’s certifications that it complied with Medicare regulations also submitted false bills. Nor could the relator support claims based on alleged violations of Medicare rules before he was employed by PCMC.
Contact a Tampa, Florida, Government Fraud Attorney Today
FCA claims are serious business. Defrauding the government, especially Medicare and Medicaid, can lead to a host of potential civil lawsuits and in some cases even criminal prosecution. So if you are involved in such a dispute it is important to work with an experienced Tampa qui tam lawyer who can guide you through the process. Contact Trombley & Hanes today to schedule a consultation.