Recent whistleblower cases and their impact

Federal and state governments recognize the tremendous impact of whistleblowers who disclose evidence of fraud, waste, and abuse involving public funds. To encourage those disclosures, the government shares a portion of recovered funds from claims brought by a whistleblower.  A number of recent whistleblower cases in Georgia and the Southeast demonstrate the significance of working with an experienced Atlanta False Claims Act lawyer.  Those lawyers ensure that a whistleblower’s best interests are protected when reporting fraud and abuse cases.

Recent whistleblower cases and their impact. A person standing in front of news media as a whistleblower

What are some recent whistleblower cases in Georgia and the Southeast?

Laboratory whistleblower

A Georgia laboratory owner recently pleaded guilty to felony criminal charges in connection with a conspiracy to pay health care kickbacks through volume-based commissions for drug tests and respiratory pathogen panels, many of which were deemed medically unnecessary.

The Georgia laboratory owner and his clinical laboratory also agreed to a $13.9 million settlement with the government to resolve related civil allegations under the whistleblower provisions of the False Claims Act. The government discovered those allegations in part through disclosures made by a whistleblower employee of the Georgia clinical laboratory.  That whistleblower employee received approximately $2.86 million of the $13.9 million settlement to reward his willingness to come forward with evidence of this fraud.

Urgent Care whistleblower

An urgent care chain in Georgia will pay $1,600,000 to resolve allegations that it submitted false claims to Medicare by upcoding claims for evaluation and management of patients during the COVID-19 pandemic.  Former employees of the urgent care chain filed a civil lawsuit disclosing those false claims under the whistleblower provisions of the False Claims Act.  Those former employees personally received $320,000 from the settlement for their disclosure of this fraud.

Laboratory whistleblower

A recent release from the South Carolina U.S. Attorney’s Office announced that one of the largest clinical laboratory services providers in the country agreed to a $19 million settlement of allegations that it submitted false claims to Medicare.  That lab allegedly induced healthcare providers to unlawfully refer their patients for testing by paying those providers “process and handling fees.”  The settlement resolved a whistleblower lawsuit brought by two private individuals who disclosed the fraud.  Those individuals received $5.6 million of the settlement.

Why is the healthcare industry so vulnerable to false claims?

The government cannot ensure that every healthcare claim sent to federal healthcare programs is legitimate.  It cannot effectively review each of the millions and millions of healthcare claims submitted across the country every year to ensure that those claims are for legitimate medical services and are properly billed and performed.  The Centers for Medicare & Medicaid Services (CMS) recent fact sheet sheds light on the enormous amount of funds spent yearly on healthcare:

  • The National Health Expenditure (NHE) is $4.5 trillion
  • Annual Medicare spending equals $944.3 billion
  • Medicaid spending costs $805.7 billion annually

Because the federal government cannot monitor this vast industry on its own, it must rely on the help of private citizens (sometimes called “relators”) who possess inside knowledge to uncover fraud.

Who are recent famous whistleblowers?

Famous whistleblowers may not always be identified by name because of the protections afforded them under the law. However, the substantial amounts they may be awarded for filing a claim on behalf of the government under the qui tam provision of the False Claims Act garners more attention.

Whistleblowers across the country recently shared $16 million for disclosing false claims submitted by a national group of psychiatric hospitals and inpatient behavioral health services facilities, including one located in Moultrie, Georgia.  In a settlement with the government, those facilities agreed to pay $122 million to resolve allegations that they billed for unnecessary services, billed for services that were never provided and paid unlawful inducements to convince federal healthcare beneficiaries to use their services.

What is the impact of recent whistleblower cases?

Federal and state governments face substantial losses from false claims each year.  In 2023 alone, the federal government announced the largest number of False Claims Act settlements and judgments in history, with an aggregate recovery to the government of $2.68 billion. More than $2.3 billion of that recovered amount was the direct result of cases filed by whistleblowers.  In 2023, whistleblowers in federal qui tam suits received over $349 million for their willingness to disclose fraud against the government.

Whistleblowers deserve relentless protection for their efforts and relentless advocacy for their efforts to bring unlawful and fraudulent conduct to light. If you have questions concerning a lawsuit under the qui tam provision of the False Claims Act, speak to an experienced Atlanta False Claims Act lawyer at Griffin Durham Tanner & Clarkson LLC by calling (404) 891-9150.