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Healthcare-Medicare-15
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

Peripheral Vascular Associates, a full-service vascular surgery practice with multiple locations in San Antonio, Tex., was ordered to pay $8.1 million in damages for submitting more than 7,000 fraudulent Medicare claims, according to evidence provided to court by three whistleblowers. These witnesses alleged that the company submitted these false claims for services before they were complete, and for services that were never actually ordered by a physician.

Under the False Claims Act, a Relator, or private party who initiates a suit, can bring forth a legal action against the alleged provider (Peripheral Vascular Associates in this case) on behalf of the U.S. Government. (That gives whistleblowers a lot of power.)

Three former Peripheral Vascular Associates employees were willing to put their names and their reputations on the line to recover money for the Medicare program. (We applaud the honesty and integrity of these individuals who took a big risk to expose these illegal acts.)

This case centers around vascular ultrasounds, which use sound waves to check the body’s circulatory system and identify blockages in arteries and veins. The bills submitted to Medicare billing for vascular ultrasounds never occurred. (It’s a good guess that they were trying to bill quickly to increase their revenue.

One whistleblower discovered that ultrasound orders had been filed on the company’s system by her on behalf of a doctor. But she knew she had not personally filed those orders, nor knew of their existence until she discovered them. (This wise woman did not want to be implicated in the scam, so she took action.)

The jury ordered Peripheral Vascular Associates to pay $2.7 million in damages, but the total tripled to $8.1 million under the False Claims Act. (That seems like a small amount to pay for intentionally defrauding American taxpayers and Medicare more than 7,000 times.)

Today’s Fraud of the Day comes from an article, “San Antonio company ordered to pay $8.1 million for fraudulent Medicare claims,” published by MySanAntonio.com on February 18, 2022.

A San Antonio jury ordered Peripheral Vascular Associates to pay $8.1 million in damages for fraudulent Medicare claims after several whistleblowers brought evidence to court.

The jury ordered Peripheral VA to pay exactly $2.7 million in damages on February 15 back to the federal government, but that total has tripled to $8.1 million under the False Claims Act, according to a news release and court documents. Justin Berger, attorney for the whistleblowers, says the False Claims Act allows these former Peripheral VA employees to bring fraudulent acts to court.

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