Whistle-blower awarded $350,000 for reporting about medically unnecessary ultrasound tests.

The Department of Justice has announced a major settlement in a case of medical billing fraud.

Acting United States Attorney W. Stephen Muldrow announces that Dr. Arthur S. Portnow . . . has agreed to pay $1.95 million to resolve allegations that he and his practice violated the False Claims Act by knowingly seeking reimbursement for medically unnecessary ultrasound tests that were performed on Medicare beneficiaries.

Dr. Portnow submitted fraudulent claims to Medicare for the evaluation and performance of medically unnecessary carotid ultrasounds, lower extremity arterial ultrasounds, abdominal aortic ultrasounds, renal and renal artery ultrasounds, and echocardiograms.

The whistleblower on this fraud was a former employee.

The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act that permits private individuals to sue on behalf of the government for false claims and to share in any recovery. The Act also allows the government to intervene and take over the action. Ms. Siwicki will receive roughly $350,000 of the proceeds of the settlement with Dr. Portnow.

The Act empowers the average worker with the same authority as if they were the government of the United States. The False Claims Act specifically allows current employees, former employees or even competitors to report fraud or illegal actions. Like the whistleblower here, the statute authorizes a reward of up to 30% of the recovery to the government.

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