PHILADELPHIA – The whistleblower in a health care fraud case against some doctors and medical facilities in Lehigh Valley is set to receive approximately $124,000, following a settlement agreement reached with the federal government worth almost $700,000.
The fraud case, which was filed in the U.S. District Court for the Eastern District of Pennsylvania, involved three physicians – Dr. Yasin Khan, Dr. Elizabeth Khan and Dr. Dong Ko – as well as the former Westfield Hospital in South Whitehall Township and other health-care facilities, including Lehigh Valley Pain Management.
The Lehigh Valley Health Network’s Center for Orthopedic Medicine took over the Westfield Hospital when the latter closed in 2013 and 2014.
All of the parties who faced allegations of fraud agreed to pay the federal government $690,441 to settle the claims linked to their purported violations of the False Claims Act. According to court documents, the defendants submitted deceitful health-care billings to the Medicare, Federal Employees Health Benefits and U.S. Department of Labor-Office of Workers’ Compensation programs.
The issue came to light following the case filed by whistleblower Margaret Reynard. By invoking the qui tam provisions of the False Claims Act, she was able to sue the aforementioned parties on behalf of the United States. In accordance with the statute, Reynard is entitled to receive part of the amount recovered by the government.
The False Claims Act provides for provisions that allow private citizens to file civil lawsuits, which are called qui tam lawsuits, against individuals or businesses they believe to be committing crimes against the government. Apart from this right, the act also grants rewards to the whistleblowers for their efforts and time to help the United States recover damages from the defendants.
As for the amount the government would reward to the person putting forward a qui tam lawsuit, the Justice Department looks into a number of factors. These include the effort and fees incurred by the whistleblower during the trial and investigation.
Generally, whistleblowers receive approximately 25 percent to 30 percent of the recovered sum if the case was pursued without the assistance or intervention of the government. For cases that have government intervention, such as this one, the whistleblower is entitled to 15 percent to 25 percent of the recovery.
In the case against the Lehigh Valley practitioners, Reynard pointed to billings that were tagged as services performed by non-physicians as “incident to” those done by the supervising physicians.
Upon investigation by the Justice Department, it alleged that the supervising physicians were not even present during the claimed hours.
By tagging it as “incident to” a supervising physician’s services, the billing becomes higher than when the services are done without the physician’s presence. This would also translate to higher reimbursement rate.
According to Reynard, this practice had been observed by the defendants from July 1, 2007, until December 31, 2013.
Following Reynard’s lawsuit against the defendants, the case was taken over by the U.S. Department of Health and Human Services Office of the Inspector General, the U.S. Office of Personnel Management Office of the Inspector General, the U.S. Postal Service Office of the Inspector General and the U.S. Department of Labor Office of the Inspector General.