Our client becomes a successful two-time whistleblower

It is difficult and rare to be a successful False Claims Act relator. First, you have to be educated enough to recognize the fraud that is occurring around you. You must be wise and confident enough to not be gaslit by your bosses that what they are doing is appropriate.

Second, you must have the integrity and fearlessness to be a whistleblower. Third, you have to bring a case significant enough to convince the government to intervene. This only happens in about 20%-25% of cases. When it doesn’t, your attorneys must litigate and win a declined case, which is even rarer.

And so you can probably count on your fingers the number of whistleblowers who twice bring successful False Claims Act cases. Not only do they have to experience that situation yet again, but they have to be willing and able to go through this difficult process a second time, with a case strong enough to again result in a successful resolution.

You can add our client, Ms. P, to that short list. This month, the government announced a $225,000 settlement with Atlanta Medical and Aesthetic Center, Inc. and its owners. The case was filed by two relators—the practice’s former nurse practitioner and former office and billing manager.

Notably, the nurse practitioner previously brought a False Claims Act case that resulted in a $430,000 ability-to-pay settlement.

This is Bracker & Marcus’s 11th intervened False Claims Act settlement since the start of 2022, totaling more than $27 million in recoveries for the government.

Midlevel providers are often in a position to witness fraud by managing providers

Ms. P doesn’t go looking for False Claims Act cases. On the contrary, when she called us about this second case, she was distraught about finding herself in another situation of fraud and potential harm to patients. She had walked out the door after being told to give a pain prescription to a patient who had not undergone an exam and whom she believed to be an addict.

In the first case that she settled, Ms. P and her co-worker alleged that the pain management physician performed unnecessary services on his patients and withheld their medications unless they agreed. She was concerned that these patients were harmed by these practices which were intended to maximize billing, not patient care. In sum, the case was based on too many unnecessary services being provided.

Here, the case is about too few necessary services being provided. The relators alleged that the managing physician of a small practice was rarely around the office or providing meaningful services to her patients. Yet, the services performed were still generally billed as if provided by the doctor, even when she was not in the country.

The relators also alleged that the patients were in and out quickly, given pre-signed prescriptions, and scarcely treated for their ailments or addictions. Still, these visits were “upcoded” to a higher reimbursing level of treatment.

The government awarded our clients for their contributions

Thankfully, Ms. P is now in a better place—both figuratively and literally. She has started her own practice and no longer will be subject to the fraudulent intentions of a managing provider. She is hopefully retired from the False Claims Act business.

Recognizing the significant contributions Ms. P and her co-relator provided to its investigation, the government awarded our clients a 20% share of the recovery. We are grateful that Ms. P trusted us twice to bring False Claims Act cases on her behalf.

We are also thankful that her co-relator, Ms. M, decided to join her in this case. Although the focus of this blog has been on Ms. P being a second-time relator, her co-worker brought substantial information and evidence that went a long way toward proving this case.

We also congratulate Assistant United States Attorney Austin Hall and Assistant Attorney General Sara Vann and their investigators for having successfully investigated and settled this case.

Contact us for a free evaluation of your False Claims Act case

If referrals are the highest form of professional compliment, then repeat business is a close second. Ms. P trusted us enough to represent her in not just one, but two separate False Claims Act cases. Her trust paid off, resulting in two separate interventions and recoveries by the United States.

We hope that you will also put your trust in us. Our initial consultation is free, and our fee comes from any recovery we might obtain for you.

If you are aware of a medical provider improperly billing the government for products or services, please contact our False Claims Act attorneys for a free evaluation.