WASHINGTON, Oct. 21, 2016 /PRNewswire/ -- One of New York State's largest oncology clinics has agreed to pay $5.5 million to settle claims of Medicare and Medicaid fraud brought by a former employee under the Federal False Claims Act. Lost dollars will be returned to the federal government and the State of New York.
According to a complaint filed in the United States District Court for the Southern District of New York in White Plains, Hudson Valley Hematology-Oncology Associates, R.L.L.P. (Hudson Valley) allegedly over billed federal and state health care systems, by up-coding to obtain reimbursement for more extensive treatment than the clinics provided and by waiving patient co-pays in a manner violating the Federal Anti-Kickback Statute.
The case is U.S. ex rel. Abrahamsen v. Hudson Valley Hematology-Oncology Associates et al. Ms. Abrahamsen, a Certified Professional Coder, is represented by the law firm of Guttman, Buschner & Brooks PLLC (GBB) and Robert T. Bernat of Bernat & Bernat, P.C.
"This is an important case which sends a message that medical practitioners at the local level will be held responsible for conduct that cheats health care systems," said GBB partner Traci Buschner.
GBB partner Justin Brooks said "This case is a victory for the American tax payer. In an era of spiraling health care costs, everyone working in the health care space needs to guard against fraudulent billing and related practices that inflate the cost of health care for everyone. We fully expect that this settlement - which is significant for claims against medical offices - will place doctors on notice and alert potential whistleblowers who want to step forward."
According to the complaint in intervention filed by the United States Attorney, Hudson Valley's practice of waiving patient co-pays "without making an individualized determination of financial hardship or exhausting reasonable collection efforts" violated the Anti-kickback Statute, a law that prohibits the "payment of kickbacks in any form to protect the Medicare and Medicaid programs because remuneration can influence health care decisions that would result in services being provided that are medically unnecessary, of poor quality, or even harmful to a vulnerable patient population."
The case was filed and resolved under the Federal False Claims Act (FCA). That statute enables the United States government to recover money it wrongfully paid as a result of fraudulent conduct and allows individuals who learn of unlawful conduct to bring a law suit in the name of the government.
The GBB team included Traci Buschner, Reuben Guttman, Justin Brooks, Liz Shofner, and Caroline Poplin, MD, JD, the firm's Medical Director.
Guttman, Buschner & Brooks PLLC, www.gbblegal.com, is one of the nation's leading whistleblower law firms. The firm's attorneys have represented whistleblowers in cases returning more than $5 billion to state and federal governments. Earlier this week GBB reported that it represented the lead whistleblower in a case against Omnicare returning 28 million to the government.
For more information on the False Claims Act go to www.whistleblowerlaws.com
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SOURCE Guttman, Buschner & Brooks PLLC