FCA Risks Soar With Release of Medicare Physician Billing Records

Attorneys specializing in bringing whistle-blower lawsuits under the False Claims Act have begun sifting through the physician billing records released by the government last week to identify sources of fraud, according to a Reuters report.

On April 9, CMS released data showing the dollar amount more than 88,000 physicians received in Medicare Part B payments in 2012, the first time in more than 35 years such information has been made publicly available.

This data is likely to spur action by attorneys who earn their living from bringing cases on behalf of employees of pharmaceutical drug companies and healthcare providers who believe their bosses or colleagues may be cheating the federal Medicare system by bribing physicians to prescribe certain drugs or inflating bills, according to the report.

In the past attorneys had to rely on their clients' personal knowledge of any suspect billings, and then subpoena government agencies for the supporting documents. Now, with the release of the Medicare physician billing data, the information is at the attorneys' fingertips, according to the report. 

If an attorney represents a whistle-blower in a successful FCA lawsuit, the prevailing whistle-blower gets 30 percent of the monetary judgment and 40 percent of that reward typically goes to the whistle-blower's attorney.

Attorney Marc Raspanti represents whistle-blowers in FCA lawsuits, and he has analyzed the Medicare data to see if physicians are prescribing an unusually high amount of a pharmaceutical company's products because that information could bolster FCA allegations, he said in the report. The physician billing data has already helped him in some of his cases, according to the report.

The recently released data could also help direct attorneys to additional targets or potential witnesses in cases they have already filed. For example, if an attorney were representing a pharmaceutical sales manager accusing his company of paying kickbacks to certain physicians, the data could point to other providers using the company's products who could serve as witnesses or be added as defendants if the billings suggest wrongdoing, according to the report. 

More Articles on False Claims Act:

Tuomey Ordered to Pay $70M While Waiting On Appeal 
Rising Scrutiny of Kwashiorkor Claims Places Hospitals at Risk of FCA Lawsuits 
5 Key False Claims, Stark & Anti-Kickback Concepts for Hospitals' Senior Leaders 

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