Health Care Professionals Pursue Whistleblower LitigationMay 17, 2018
Qui tam litigation can be a complex and exhausting process. If the case is not settled and must go to trial, it can take even longer to reach a resolution. In a case that dates to 2015, United States of America, et al v. BlueWave Healthcare Consultants, Inc., et al. has yet to be fully resolved.
The plaintiffs, the owner and operator of a Florence, South Carolina health care billing company, and a Registered Nurse for a home health agency in Florence, in addition to an assemblage of individual relators, filed a qui tam action on behalf of the United States and the governments of 18 states.
The relators alleged that BlueWave Healthcare Consultants, Inc., along with other laboratories for which BlueWave provided marketing services, including Health Diagnostic Laboratory, Inc. (HDL), Singulex, Inc., and Berkeley Heartlab, Inc., committed healthcare fraud. The plaintiffs charged the defendants, specifically BlueWave executives and HDL CEO and founder, with submitting several hundred thousand falsified reimbursement claims to government-sponsored healthcare programs, like Medicare and TRICARE, in exchange for laboratory testing referrals.
The plaintiffs also asserted that BlueWave, HDL, Singulex, Inc., and a group of their executives coaxed physicians to refer laboratory testing business to HDL and Singulex, Inc., then recouped reimbursement for certain tests from Medicare and TRICARE. Compensation for processing and handling fees were fraudulent, the testing was medically unnecessary and duplicative, and HDL and Singulex, Inc. paid BlueWave a commission based on their revenue, according to the plaintiffs.
With a combination of fraudulent processing and handling fess and declining copays from physicians, the above-mentioned causes were the impetus for the qui tam action, all of which are violations of the federal False Claims Act and Anti-Kickback Statute, with the government seeking triple the amount of damages.
Jury Returns Unanimous Verdict
HDL and Singulex, Inc. agreed to pay $47 million and $1.5 million in addition to the remaining common law claims while entering into corporate integrity agreements with the Department of Health and Human Services, to resolve all allegations that they violated under the False Claims Act in April 2015.
The Court has not ruled on the defendants’ request for judgement as a matter of law or new trial. The Court denied the motion from BlueWave executives for a new trial due to juror misconduct but has not ruled on their remaining grounds for judgement as a matter of law or new trial.
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