Long Island’s largest radiology practice, Zwanger-Pesiri, pled guilty to criminal health care fraud and agreed to pay the government millions of dollars in civil and criminal penalties. Thanks to qui tam laws, two employees of Zwanger Pesiri filed a lawsuit and directed the United States Justice Department to evidence that the practice has been unlawfully billing patients and ordering tests, at the expense of the United States and New York State governments.
The federal False Claims Act (FCA) exists to protect and incentivize individuals to report fraudulent and other unlawful practices. The Act allows someone to file a civil case when he or she finds evidence that a person or entity is committing fraud against the government. A case alleging the commission of fraud against the government is called a qui tam lawsuit or action. Under the FCA, the person who files the lawsuit, called the relator, may be entitled to receive a percentage of any money recouped for the government and receive job protection. In this way, the act rewards whistleblowers and provides incentives to come forward and report irregularities despite the personal and professional risks in doing so.
A qui tam case is filed “under seal.” Under seal means that the details are private and not disclosed to anyone but the government. The Justice Department uses this time to investigate the allegations. The qui tam lawsuit and supporting documents should give the government detailed information about the fraud so the department can conduct a proper investigation without necessarily notifying the defendant. In the Zwanger-Pesiri case, because New York State and the Federal government jointly fund Medicaid, both played a part in the investigation.
Once the government investigates the allegations, it must decide whether it will join, or “intervene,” in the case. Government intervention is not required to proceed with a qui tam action, but it helps the chances of success. Many qui tam cases settle without a trial, but a trial is not out of the question.
Two employees of Zwanger-Pesiri Radiology filed a qui tam action in the US District Court for the Eastern District of New York in 2013. The radiology practice has locations across Long Island providing imaging, testing, and diagnostic services to patients. Linda Gibb began working at Zwanger-Pesiri in 2010 and “quickly suspected something wasn’t adding up.”
Gibb noticed that when some patients came in for a particular test prescribed by their doctor, someone in the office automatically put them on the schedule for additional tests that were not ordered by any treating physician. For example, women who came in for one imaging test often received automatic appointments for ultrasounds. At other times, the practice received doctors’ orders to perform one of two tests and performed both.
The qui tam suit also contains allegations that Zwanger-Pesiri submitted false Medicare/Medicaid claims by asserting that doctors who performed certain tests were enrolled Medicare providers when they weren’t. The practice should not have billed Medicare for these tests or received payments for them.
As part of an agreement, Zwanger-Pesiri will pay $8,153,727 to resolve allegations that the defendants knowingly filed false claims to Medicare and Medicaid. The company will also submit to billing oversight for five years. New York’s share of this recovery is over 1.2 million. New York State will pay the relators, Gibb and Donna Geraci, each about $200,000.
The FCA protects individuals who witness unlawful fraud against the government. If you work for a contractor, medical practice or other entity and have evidence of fraudulent billing or other illegal activities, contact Leeds Brown. Our qui tam attorneys can help determine if you have a valid claim and counsel you on how to proceed to protect your personal and professional interests. You can reach Leeds Brown 24/7 at 1-800-585-4658.