Qui tam lawyers at Pintas & Mullins Law Firm report that a Florida dermatologist recently agreed to pay more than $26 million for accepting illegal kickbacks. A pathologist who previously worked for the doctor filed the whistleblower case under the qui tam terms of the False Claims Act.
In 1997, Dr. Steven Wasserman entered into an arrangement with Tampa Pathology Laboratory (TPL), specifically with the lab’s owner, Dr. Jose SuarezHoyos. In an effort to increase the lab’s revenue and referral business, Dr. Wasserman agreed to send Medicare beneficiaries’ biopsy specimens to TPL for testing and diagnostics. Per the agreement, Dr. Wasserman would receive a pathology report back from TPL that he would sign so it would appear he ran the diagnostics himself. Dr. Wasserman would then send Medicare the bill for TPL’s work, making it seem as if he had done it, for which he would receive compensation.
Over time, Dr. Wasserman received more than $6 million in Medicare payments. He also significantly increased the amount of skin biopsies on Medicare beneficiaries and performed thousands of unnecessary skin surgeries. The surgeries he performed are called adjacent tissue transfers, which are very complicated and time-consuming procedures used most often to fix defects from removing a growth on patient’s skin.
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The U.S. Justice Department alleged in its lawsuit that many of these surgeries were performed not because they were medically necessary, but because Dr. Wasserman wanted to receive the kickback payments. Performing unnecessary surgeries, especially ones with high risks of complications, not only puts patients at risk, but drains taxpayers by raising the cost of health care.
The man who filed the initial lawsuit against Dr. Wasserman, Dr. Alan Freedman, was a former pathologist at TPL. Under the False Claims Act, an individual may file a lawsuit for false claims on behalf of the federal government and is entitled to a share of the recovery. In these whistleblower cases, the government has the right to get involved in the matter, and in this case it did. The U.S. filed its own lawsuit in October 2010, and the $26 million settlement was agreed upon on February 11, 2013.
Dr. Freedman received 6.5% of the settlement – more than $4 million. It is one of the largest settlements in national history with an individual under the False Claims Act. Dr. Wasserman is also now disallowed from treating patients and barred from being paid by Medicare, Medicaid, and other federal health care programs. In the same lawsuit, TPL and Dr. SuarezHoyos settled for $950,000.
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The investigation was conducted by special agents with the Department of Health and Human Services – OIG and the FBI as part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative. This was enacted in 2009 in a partnership between the Attorney General and the Secretary of the Department of Health and Human Services. The initiative’s aim is to reduce and prevent Medicaid and Medicare financial aid. Since 2009, the Justice Department has recovered more than $14 billion through the False Claims Act and HEAT initiative.
Unfortunately, the type of arrangement between Dr. Wasserman and Dr. SuarezHoyos is not uncommon. This case is remarkably similar to another recent qui tam lawsuit against Bostwick Laboratories. The lab was allegedly performed testing on atypical urine cytology cases and billed Medicare for them, even if the referring physician did not order the tests.
Qui tam laws protect whistleblowers from being fired or retaliated against in terms of their employment if they report their employer. The most common whistleblowers are employees, former employees, competitors, and subcontractors.
Whistleblower lawyers at Pintas & Mullins Law Firm remind the public that if you uncover a situation where you believe the government is being defrauded, it is very important that you speak with an attorney before speaking with anyone else about the case. Letting others know may compromise your entitlement, as only the first individual to file a claim has the right to compensation.