A pathologist who formerly worked at a clinical laboratory will receive $4,046,000 as a reward for filing a whistleblower lawsuit that exposed fraudulent Medicare billing practices, including the payment of illegal kickbacks and the billing of medically unnecessary services to the Medicare program.

Based on information provided by the whistleblower doctor, the government alleged that Steven J. Wasserman, M.D., a dermatologist, entered into an illegal kickback arrangement with Tampa Pathology Laboratory (TPL), a clinical laboratory in Tampa, Fla., and Dr. José SuarezHoyos, a pathologist and the owner of TPL, in an effort to increase the lab’s referral business.   Under that agreement, Dr. Wasserman allegedly sent biopsy specimens for Medicare beneficiaries to TPL for testing and diagnosis.  In return, TPL allegedly provided Dr. Wasserman a diagnosis on a pathology report that included a signature line for Dr. Wasserman to make it appear to Medicare that he had performed the diagnostic work that TPL had performed.   The government alleged that Dr. Wasserman then billed the Medicare program for TPL’s work, passing it off as his own, for which he received more than $6 million in Medicare payments.   In addition, the government asserted that, in furtherance of his agreement with TPL, Dr. Wasserman substantially increased the number of skin biopsies he performed on Medicare patients, thus increasing the referral business for TPL.

The government further alleged that, in addition to his involvement in the alleged kickback scheme, Dr. Wasserman also performed thousands of unnecessary skin surgeries known as adjacent tissue transfers on Medicare beneficiaries.   The government alleged that Dr. Wasserman performed many of these procedures in order to obtain the reimbursement for them, and not because they were medically necessary.

To resolve these allegations, Dr. Wasserman agreed to pay $26.1 million.  The United States previously settled with TPL and Dr. SuarezHoyos for $950,000 to resolve the allegations asserted against them in the same lawsuit.  The claims settled by these agreements are allegations only; there has been no determination of liability.

For more information on this case, click here: http://www.justice.gov/opa/pr/2013/February/13-civ-183.html

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