A doctor and a nurse formerly employed by DaVita Inc. have sued the dialysis provider for violations of the federal False Claims Act. The whistleblowers claim that DaVita purposely ordered oversized vials of dialysis drugs and then discarded the excess while charging Medicare for the entire quantity. Medicare rules have since been changed to disallow billing for individual drug doses, instead requiring “bundled” reimbursement for all services rendered to a patient. However, the plaintiffs allege that seven years of improper billing at DaVita under the old rule resulted in taxpayer losses of more than $800 million.

As in all False Claims Act cases, the government is the real party in interest, and in this case the government has declined to intervene. Under the False Claims Act, however, a qui tam whistleblower may continue to prosecute the case in the government’s shoes. In many declined cases, as here, the government reserves the right to intervene at a later time. A lawyer for the whistleblowers expressed his continued confidence in the case, pointing to the recent $55 million settlement by DaVita in another declined case. DaVita, which is the second-largest dialysis provider in the United States, denies wrongdoing.

Read the entire article, “Whistle-blowers say dialysis firm bilked Medicare”