A whistleblower who sued a group of Atlanta-area orthopedic and anesthesia providers for their alleged participation in an illegal kickback scheme has helped the U.S. government recover $3.2 million for Medicare.
According to the U.S. Department of Justice (DOJ), the whistleblower lawsuit led to a settlement agreement between the federal government and Georgia Bone & Joint; Summit Orthopaedic Surgery Center; Southern Crescent Anesthesiology; and Sentry Anesthesia Management, as well as nurse anesthetist David LaGuardia.
The whistleblower complaint, brought by Sharon Kopko, former Practice Administrator for Georgia Bone & Joint, alleged that Mr. LaGuardia, Sentry, and Southern Crescent provided a free medical director to Summit Surgery Center to induce it to perform more procedures at the surgery center rather than in the Georgia Bone & Joint office.
The complaint further alleges that Georgia Bone & Joint and Mr. LaGuardia submitted false claims to Medicare for prescription drugs that weren’t approved by the U.S. Food and Drug Administration (FDA) and bought outside the U.S.
The federal government prohibits health care providers and drug companies that bill Medicare and other taxpayer-funded programs from engaging in kickback schemes, which prioritize profits over patient care and can corrupt medical decisions.
“Kickbacks should never play a role in medical decision-making,” said U.S. Attorney for the Northern District of Georgia Byung J. “BJay” Pak. “It is critical to our health care system that patients seeking health care know that their providers’ recommendations are based on what is in the patient’s best interests and not influenced by illegal kickbacks or arrangements.”
Ms. Kopko filed the lawsuit under the whistleblower provisions of the False Claims Act, which allows private parties to sue on behalf of the U.S. in cases of fraud targeting federal programs and agencies. Whistleblowers whose False Claims Act lawsuits lead to a judgment or settlement receive up to 25 percent of the total recovery or up to 30 percent in cases that federal prosecutors declined to litigate.
The U.S. Attorney did not specify how much of a whistleblower award Ms. Kopko will receive.