July 1, 2021.  When you go to a doctor’s office, you have a reasonable expectation that you will either be treated or referred appropriately for your illness or injury.  Allegations against a now-deceased urologist include that the physician performed medically unnecessary lithotripsy (kidney stone) procedures and then billed Medicare and TRICARE for those procedures, including procedures on patients who did not even have kidney stones.  The doctor allegedly received per-procedure payments from an outpatient surgery center, in a kickback arrangement vetted and approved by an affiliate.

The United States Department of Justice settled a case against these two Orlando, FL-based surgery centers for kickbacks related to performing these medically unnecessary and fraudulently billed kidney stone procedures.  Under the terms of the settlement, the surgery center paid the government $3.4 million for violations of the Anti-Kickback Statute and False Claims Act.

The whistleblower will receive $748,000 of the proceeds from the settlement.  The same whistleblower also previously received $385,000 from an earlier settlement between the and the doctor’s estate. Medicare and Medicaid spending comprise most health expenditures in the United States.  Fraudulent manipulation of Medicare and TRICARE not only harms vulnerable portions of the population but also defrauds taxpayers who fund these programs. The False Claims Act empowers whistleblowers to report people and companies who perpetuate fraud, waste, abuse, and mismanagement in government programs.