The Justice Department announced last week that a Florida-based radiology billing company will pay nearly $2 million to settle claims that it knowingly changed billing codes to Medicare and Medicaid in order to get previously rejected claims paid out. The settlement resolves a whistleblower claim filed by relator, Katlisa N. Vaughn, who will receive a share of the recoveries for her role in exposing the fraud.
Medicare and Medicaid have guidelines stating that neither will pay for certain procedure s that are provided to patients with specific diagnoses. In an effort to avoid these restrictions, Vaughn claims that Medical Business Service, Inc. changed the codes for claims that Medicare and Medicaid had previously rejected. The alleged fraud took place between 2008 and 2010.
According to the FBI, the federal government will receive $1.917 million, with the states of Texas, New York, Florida and Georgia splitting much of the remaining portion. Vaughn will also receive a whistleblower reward, though the amount has not yet been revealed.
Since 2009, the Justice Department has recovered over $20 billion from False Claims Act cases. This case demonstrates the need for whistleblowers to come forward and expose health care fraud. If you have information concerning health care fraud at your place of work, it is in your best interest to contact an experienced whistleblower attorney to discuss your case. If your information leads to the successful recovery of government funds, you may be entitled to compensation.