Provided by:  Jennifer Kirschenbaum, Esq.

November 16, 2021

The False Claims Act is federal laws that prohibits a person or organization from knowingly making a false record or file a false claim regarding any federal health care programs.  Under the False Claims Act qui tam provisions, any person (i.e., whistleblower) with evidence of fraud may sue the wrongdoer on behalf of the United States and recover a portion of monies the defendant falsely submitted for reimbursement, once recovered.  

In a recent reporting, the whistleblower and federal government recovered over $700k from a Wisconsin pediatric practice accused of submitted false claims to Medicaid for unnecessary testing and treatments and non-reimbursable office visits. The United States further alleged that Pediatric Associates provided more aggressive testing protocols for patients with Medicaid as opposed to patients with private health insurance. The way this matter progressed, the whistleblower bought the action first, and invited the government to participate. Since the government elected to take over, the amount the whistleblower kept was decreased. Here, we do not know if the allegations are true; we know the doctor elected to settle as opposed to risking an outcome at trial.