If seeking to report dialysis fraud, one of the important tool’s in a whistleblower’s arsenal is the False Claims Act. The qui tam cases against dialysis companies have convoluted theories and often result in hard fought litigation. Below are some examples of successful qui tam cases against dialysis companies.
Dialysis Fraud Settlements
There have been numerous qui tam settlements regarding dialysis fraud. For example, in 2015, Davita settled a qui tam case for about $450 million. The qui tam complaint alleged that Davita created an unnecessary waste of drugs when administering dialysis drugs to Medicare patients. Then Davita charged the government for the wasted drug amounts. Despite the fact that the government declined to intervene in the case, the case settled.
In 2014, a whistlblower sought to report dialysis fraud and filed a case against Davita. This case was different than the wasting case. This case involved violations of the kickback statute. The qui tam case alleged that DaVita offered physicians joint venture opportunities (kickbacks) in return for referrals. This dialysis fraud case settled for $350 million.
Report Dialysis Fraud Against Private Insurance Companies
Typically dialysis is covered by Medicare. However, if an individual is seeking to report dialysis fraud by filing a qui tam case related to Medicare/Medicaid, then the whistleblower’s lawyer should also investigate if private insurance companies were defrauded by the same conduct. in sum, ff private insurance companies are also defrauded, the whistleblower might have a case under the California Insurance Fraud Prevention Act or CIFPA. Examples of cases brought under the CIFPA to report dialysis fraud can be instructive.
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