Doctors Play a Critical Role as Whistleblowers Against Medicare Fraud
On March 27, 2024, the Department of Justice (DOJ) announced that Gamma Healthcare, Inc, a clinical laboratory headquartered in Missouri, had agreed to pay $13.6 million for submitting claims to Medicare for laboratory tests that were not medically necessary or ordered by physicians. The DOJ alleges that Gamma automatically performed an additional, expensive PCR urinalysis test – costing $573 – every time a physician ordered a simple urinalysis, for which Medicare pays $11. The requisition form was structured so that physicians could not opt out of the more expensive test. The whistleblower in the qui tam case that led to the settlement was a doctor who had used Gamma to perform laboratory tests for his patients. The whistleblower doctor will receive a reward of $2.3 million from the settlement proceeds.
Remarkably, this fact pattern almost exactly mirrors one that permeated the clinical testing laboratory industry almost 30 years ago, resulting in succession of qui tam lawsuits that recovered $2 billion for taxpayers – that’s $4 billion in today’s money. Getnick Law filed one of those lawsuits on behalf of a North Carolina doctor who reported that Roche Biomedical Laboratory (now Labcorp) automatically performed an add-on thyroid test every time he ordered a simple thyroid test. Despite his protests, Roche refused to stop performing, and billing Medicare, for the additional test. His qui tam lawsuit was resolved in 1996 for $187 million, including a criminal guilty plea by Labcorp. As the government’s “Operation Labscam” investigation progressed, it emerged that billing Medicare for all manner of additional tests that were not medically necessary or affirmatively ordered by physicians was more-or-less standard industry practice. The government believed then that it had successfully shut down these scams, but the Gamma case shows that whistleblowers – particularly medical professionals who are well-positioned to detect fraud that would otherwise remain hidden – are just as critical to keeping Medicare dollars safe as they were three decades ago.
Getnick Law is one of the nation’s preeminent whistleblower firms. We have recovered more than $1 billion for the government and achieved record awards for our clients. To contact a Getnick Law attorney to discuss potential whistleblower representation, please click here or call us on (212) 376-5666.