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Whistleblowers to get $4,276,900 reward in improper billing case

A company called Healogics, Inc., has agreed to settle False Claims Act allegations for up to $22.51 million. The Florida company, which manages almost 700 hospital-based wound care centers nationwide, is accused of knowingly causing their wound care centers to falsely bill Medicare for hyperbaric oxygen ("HBO") therapy that was either unreasonable or medically unnecessary.

When people suffer from certain chronic wounds, HBO therapy can be used as an adjunctive therapy. During HBO therapy, the patient's entire body is exposed to oxygen at increased atmospheric pressure. The Justice Department says that Healogics submitted the false claims or caused their submission between 2010 and 2015.

As a result of the Justice Department's findings, Healogics will pay $17.5 million, along with an additional $5.01 million should specific financial contingencies occur over the next five years. That brings its total liability to a possible $22.51 million.

The company has also entered into a five-year corporate integrity agreement with the Department of Health and Human Services Office of Inspector General. During that agreement, an independent review organization will perform both a claims review and a systems review of Healogics, among other things.

"When greed is the primary factor in performing medically unnecessary health care procedures on Medicare beneficiaries, both patient well-being and taxpayer funds are compromised," said a spokesperson for the HHS OIG.

Four whistleblowers filed two separate lawsuits against Healogics under the False Claims Act, which allows private citizens with knowledge of fraud against the government to sue on the government's behalf and collect a share in any recovery. In this case, Healogics' former director for research and quality for medical affairs filed one lawsuit. The other was filed by two doctors and a former program director who were employed at Healogics wound care centers. The government can intervene in such lawsuits, as it did here, and that can increase the chance of their success.

The four whistleblowers could share up to $4,276,900, depending on whether certain financial contingencies occur to drive up Healogics' settlement.

Every patient deserves to have their medical decisions made based on their clinical needs, not greed. If you work for a company that provides Medicare, Medicaid, TRICARE or other government-sponsored healthcare services, you may be in a position to notice fraud, waste or abuse. If you do and are interested in filing a False Claims Act lawsuit, we urge you to contact an attorney familiar with handling these claims.

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