Medical clinics Prime Care on the Bay (Prime Care) and Bensonhurst Mega Medical Care, P.C. (Bensonhurst) have pleaded guilty to conspiracy to commit health care fraud. Prime Care and Bensonhurst, located in Brooklyn, New York, along with several individuals associated with the two clinics, submitted $55 million in false and fraudulent claims to Medicare and Medicaid. The scheme involved subjecting patients to medically unnecessary health services provided by unqualified staff. The two clinics admitted further that, in order to cover up the fraud, occupational and physical therapists falsified patient charts and medical billings. Moreover, one of the Defendants admitted they paid the patients to attend these clinics and the Defendants opened a bank account for the sole purpose of laundering funds and paying these illegal kickback payments.
In the government’s battle against fraud, the False Claims Act (FCA) has become an invaluable weapon. The FCA contains a qui tam provision that permits individuals to not only blow the whistle on fraud, it also provides incentives for individuals to step forward and report fraud. These incentives include 15 to 30 percent of the funds recovered by the government, as well as protection against retaliation. The monies recovered through the FCA replenish the tax pool and serve to deter other companies from committing the same fraud.
One of the largest areas of FCA litigation is health care fraud. For example, since January 2009, the government has recovered $19.3 billion from health care fraud actions alone. The qui tam provision provides an avenue for ordinary citizens to aid the government in detecting and deterring health care fraud. Furthermore, the FCA both protects and rewards those brave individuals who step forward and report fraud.
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