Oftentimes, qui tam relators first raise their concerns publicly. However, whether it is on the public pulpit or up the chain of command of a dishonest employer, their voices are, too often, tuned out to the detriment of the public fisc.

Thankfully, federal and state False Claims Acts provide a viable avenue for exposing fraud. By deputizing private citizens, the qui tam provisions of the False Claims Act empower individuals in their fight against corporate fraudsters.

A recent $70 million False Claims Act settlement involving New York City is a perfect example of why we need the False Claims Act. In this case, Dr. Gabriel Feldman, a board-certified preventive medicine physician, was employed by the New York County Health Services Review Organization (NYCHSRO) as a local medical director, and he was tasked with determining whether Medicaid patients qualified for 24-hour personal care services (PCS) under Medicaid’s PCS program. However, time and time again, the City of New York overruled his PCS determinations, improperly authorizing PCS for thousands of New York Medicaid beneficiaries.

Since 1993, Dr. Feldman voices his concerns, both internally and externally. For example, Dr. Feldman testified publicly before the New York City Council in 1993, stating that the City’s PCS program was causing the government to make unjustified payments representing, “…hundreds of millions of dollars in Medicaid waste.”  He also complained repeatedly to his supervisors at the NYCHSRO. However, each time, his concerns fell on deaf ears.

Finally, in 2009, Dr. Feldman filed a qui tam action against the City, laying out the allegations of fraud and detailing the City’s complete disregard for the applicable Medicaid regulations.

Recently, the City of New York finally listened, when it inked a check for $70 million. For his courageous efforts, Dr. Feldman received a handsome reward of $14.5 million.

For more information about qui tam law and healthcare fraud, contact Nolan & Auerbach, P.A.