Defendants allegedly defrauded Medicare and Medicaid by submitting false claims for name brand viscosupplements
Just in time for the new year, Bracker & Marcus is pleased to announce a settlement in its long-running case against two orthopedic practices and its owner.
Defendants Mitias Orthopaedics, a subsidiary, and its owner will repay over $1.87 million to the government. This settles allegations that they injected Medicare and Medicaid beneficiaries with drugs purchased from compound pharmacies that were billed as FDA-approved, name-brand products.
Learn more about this historic settlement and contact a healthcare fraud attorney if you suspect a healthcare provider of improper billing.
Making History in Mississippi
This is the first qui tam case intervened or settled in the history of the Northern District of Mississippi.
In January 2020, the United States intervened in the case after a lengthy investigation. The Assistant U.S. Attorney for the Northern District of Mississippi, Harland Webster, was brand new to the False Claims Act but was a seasoned trial attorney.
Bracker & Marcus LLC partner Jason Marcus was an experienced False Claims Act practitioner but had limited trial experience. It was a match made in Mississippi, as Jason handled the heavy lifting on briefing the law while AUSA Webster masterfully handled the depositions and trial preparations.
In recognition of our contributions to the case, our relator (who prefers to remain anonymous) was given a 25% relator’s share. This is the maximum possible relator’s share for an intervened case.
Mitias Orthopaedics Allegedly Billed for Products It Never Dispensed
From 2008 through 2015, the government alleges that the defendants were submitting false claims to Medicare and Medicaid for brand-name knee injections that were not administered to the beneficiaries of those programs.
The products, called viscosupplements, are gel-like fluids made with hyaluronic acid that are injected into osteoarthritic knees. Their purpose is to lubricate the knee and enable the bones to move more smoothly, reducing pain.
The FDA has approved only a small number of these products. The Centers for Medicare & Medicaid Services (CMS) gave them each their own billing codes.
The relator and the government alleged that the defendants used viscosupplements made in compound pharmacies and outsource facilities. However, they billed the government for FDA-approved products like Synvisc, Orthovisc, and Supartz.
In total, the government determined that the Medicare and Medicaid programs had reimbursed the defendants nearly $1 million for these compounded products. The defendants deny the allegations but agreed to a settlement amount of $1,870,714.83, plus interest.
This amount reflects 210% of what Medicare paid and 100% of what Medicaid paid defendants for the products in question.
This recovery of the entire payment amount, plus a penalty of about 90%, sends a message to wrongdoers in the district. The government intends not just to recoup its money but to teach a lesson to those who commit fraud.
Our Whistleblower Client Is Pleased With the Results
Bracker & Marcus filed this False Claims Act lawsuit in July 2015. In fact, it was only the fifth qui tam case that we prepared and filed as a new law firm after opening our doors that January (and all five cases resulted in settlements!).
Now, seven years and dozens of whistleblower cases later, we are extremely pleased to have reached a favorable resolution.
Congratulations to our client for having successfully concluded this more than seven-and-a-half-year journey with a sizable settlement. We asked our client for his thoughts on the resolution of this case. Here is what he said:
“There are a lot of things in healthcare that are ‘wrong,’ but that does not necessarily mean they are illegal. I knew that this situation was very different. Not only did I believe that fraud was being committed, but I thought that patients might be at risk. It was important to me that this issue be brought to the government’s attention.
The team at Bracker & Marcus communicated regularly with me throughout the entire process, including guiding me through discovery and my deposition. I know they worked tirelessly behind the scenes. I am very grateful that they agreed to bring this case on my behalf and that the government intervened and litigated this case to a successful conclusion.”
We are grateful our client put his faith in us. It was an honor to represent him.
Contact Us for a Free Evaluation of Medical Billing Fraud
Our thanks go out to Harland Webster and his team at the U.S. Attorney’s Office for the Northern District of Mississippi for their dogged pursuit of our claims.
Bracker & Marcus thinks fraudsters should pay, whether the damages are big or small. If you are aware of a medical provider billing the government for products or services not being rendered, or for upcoding products and services for additional reimbursement, please contact our firm for a free evaluation.