Georgia requires licensed nurses to perform infusions; our whistleblower nurse discovered her co-workers were unqualified medical assistants.

Bracker & Marcus LLC is pleased to announce that the federal government has intervened in and settled its False Claims Act case against Infectious Disease Consultants, P.C. (IDC) for $325,000.

IDC is an Atlanta area provider of infectious disease management and care. Our client alleged that IDC allowed medical assistants to perform IV infusion therapy (IVIT) and Immunoglobulin replacement therapy (IVIG) on its patients, for which it billed Medicare. Georgia rules and regulations require a nursing license to perform these services. Our client will receive a 20.25% relator’s share from the government’s recovery.

Keep reading to learn more about the case and how a healthcare fraud attorney assists whistleblowers.

Nurse Blows Whistle on Healthcare Fraud

Our whistleblower is a former IDC employee, a nurse who was properly qualified to perform the infusions. She and her colleagues were referred to as “infusion nurses,” causing her, and the patients, to believe that they were all nurses.

Our client learned that the other infusion nurses were not nurses at all, but medical assistants. Furthermore, they sometimes performed infusions without a medical provider present in the facility. She raised her concerns with management that it was unsafe to perform, and improper to bill, the infusions.

Soon thereafter, our client was given notice that her employment was being terminated. Her claim of whistleblower retaliation under the False Claims Act remains pending.

Medical services performed by unqualified individuals are a common healthcare fraud scheme. Providers employ low-wage workers to perform highly reimbursable services. This, in turn, can put patients at risk.

In Universal Health Services, Inc. v. United States ex rel. Escobar, the United States Supreme Court discussed the importance of medical providers being qualified to perform the services they are providing and billing for. In that case, a patient at a mental health facility had died of a seizure. She had an adverse reaction to a medication prescribed by an unqualified provider after receiving mental health counseling from unqualified therapists.

The Supreme Court held that billing the government for those services constituted a violation of the False Claims Act.

Infusion therapy is the administration of drugs by inserting a needle or catheter into the vein and then dispensing the drugs through an IV drip over the course of many hours. In our case, our client was concerned that patients could have side effects from the infusions, such as an embolism causing a stroke or acute renal failure.

Moreover, because the infusion nurses had not gone to school for nursing, some did not know how to properly calculate the “drip rate”, i.e., how quickly to infuse the drugs. For these reasons, the state of Georgia requires at least a nursing license to perform infusions.

State Law Applies in FCA Cases

Government programs like Medicare rely on state law to govern the provision of services, and so even though other states may permit medical assistants to perform infusions, Georgia law governed these services that were performed and billed in Georgia.

Thus, even though Medicare is a nationwide program, actions in one state may violate rules and may constitute a False Claims Act violation, while those same actions may be entirely legitimate when performed in another state.

Medical providers are expected to know the laws of the state they are practicing in. Similarly, if they wish to bill Medicare or other government healthcare programs, they are expected to learn the rules and regulations that govern the programs. The Supreme Court has described this as “turn[ing] square corners when they deal with the Government.” In other words, no shortcuts are allowed.

Here, our client warned IDC that it was violating the law, and it not only disregarded those warnings, but it terminated her employment.

Thank You, Whistleblowers

Our client knew that this was not a large case and was not likely to result in a sizable monetary award. Nevertheless, she came to us because she was concerned that patients were in danger. She feared that a patient could have a stroke because a medical assistant miscalculated their drip rate and that there might not be a physician on-site to help them.

By bringing this lawsuit, our client accomplished her goal: IDC has hired nurses to conduct all of its infusions at each of its locations.

We are proud of our client for having brought this matter to the attention of the government. We are grateful to Assistant United States Attorney Bowen Shoemaker, from the Middle District of Georgia, for her hard work in securing a successful settlement.

If you are aware of a medical provider performing services for which it is not qualified, you may have a False Claims Act case. Contact our firm for a free evaluation.