My whistleblower clients always want to know,
is the Government going to be interested in my case?
The answer to that question is complex — so much so that I wrote
a five-part series on it,
Top 10 Ways to Get the Government Interested in Your Case.
But one of the most important factors will be how much money the Government
lost as a result of the fraud the whistleblower knows about. The Government
only devotes limited resources to searching out fraud, and it wants the
most bang for its buck.
How Big Is Big Enough?
One way to figure out whether your case is big enough, financially speaking,
it to look at what cases the Government has settled in the past.
In 2015, the Government settled 153 cases and only three of those cases
settled for less than $100,000. On the other hand, you also could take
the opposite view — the Government was willing to push three cases
through to settlement even thought the dollar value of each was under $100,000.
Thirty-five of the 153 lawsuits resolved for under $1,000,000. (In many
of those cases, however, there is a good chance the whistleblower and
the Government started out thinking the lawsuit was worth much more.)
The Smallest Cases of 2015
- DOJ went after an Iowa chiropractor who was billing for unnecessary procedures
and conditions that were not approved for Medicaid reimbursement. The
case settled for $62,349.
- Life Focus Center of Charlestown, Massachusetts paid $94,000 after it was
accused of not providing services to a single MassHealth recipient. The
Center had submitted claims for providing day habilitation services to
a developmentally disabled person who was not attending the day care on
any regular basis, and maybe not at all.
- The U.S. accused the Jacksonville Center for Reproductive Medicine and
its owner, Dr. Michael Fox, of upcoding reproductive services. (The Government
grades medical services based on factors such as how intensive they are
and how long they take. “Upcoding” means that a medical provider
is charging the Government for providing an expensive service, when in
fact the provider is providing a service that is worth a lower dollar
value.) The Center and owner paid the Government $ 98,839 to settle the claims.
What We Can Learn from the Smallest Cases of 2015
The three smallest cases of 2015 shared one key characteristic: they were
— relatively speaking — simple and easy to prove. The case
about the day care was particularly uncomplicated: the key issues were
whether one, single individual came to the day care and whether the day
care billed for him even though he was not attending. The takeaway? While
the Government may prefer a big dollar case, it also may be willing to
reach out and grab low-hanging fruit.