Court Revives Medicare Suit From Whistleblower

Published: 2011-03-07 10:11:10

  A whistleblower who reported her employer for overbilling Medicare on chiropractic services can still pursue her complaint, and collect a tidy finder's fee in the event of a verdict, despite reports of pervasive fraud among chiropractors nationwide, the 7th Circuit ruled.
     Kelley Baltazar, a former employee of Advanced Healthcare Associates, alleged that the firm's staff regularly added extra services to billing slips and changed the codes for services that were actually performed, allowing for greater reimbursements. She accused Lillian Warden, the firm's owner, of endorsing the operation in a qui tam suit under the False Claims Act.
     The chiropractor had dismissed the suit under the argument that the claims were best brought the United States, eligible for full recovery in the event of a verdict, because qui tam suits cannot be based on public allegations or transactions.
     In 2005, the Department of Health and Human Services Office of Inspector General released a report that concluded 57 percent of claims submitted by chiropractors were for services not covered by Medicare, and another 16 percent of services were miscoded.