Sarasota Doctor Pays $1.95 Million to Settle Whistleblower Team’s Lawsuit Alleging Medicare Fraud

Our whistleblower team at Morgan & Morgan announces that a Sarasota doctor has agreed to pay $1.95 million to settle our client’s lawsuit accusing the doctor of billing the government for unnecessary ultrasounds performed on Medicare patients.

Morgan & Morgan represented Kathleen Siwicki, a former employee of Dr. Arthur S. Portnow and his Apple Medical Group. Siwicki alleged that from August 2009 to August 2017, Portnow submitted fraudulent claims to Medicare in order to perform medically unnecessary carotid, lower-extremity arterial, abdominal aortic and renal and renal artery ultrasounds, in addition to unnecessary echocardiograms. The doctor and his clinic are also accused of falsifying patient records in order to justify the unnecessary procedures. All in all, Dr. Portnow and his practice are accused of receiving hundreds of thousands of dollars as a result of the illegal testing.

Whistleblower attorney James Young, senior investigator David Reign, a retired FBI special agent, and the team worked closely with their client to gather evidence and build a case to expose the alleged fraud scheme. AUSA Chris Tuite and the government’s nurse analyst Lori Bloom also worked tirelessly, going through medical records and chronologies to build and support this case.

“Ms. Siwicki was able to walk us through both the technical aspects of the medical procedures being performed and the fraudulent billing that was occurring,” Reign said. “She worked tirelessly to make sure the government fully understood the issues and fraud that was being committed. Without the efforts of people like Ms. Siwicki, the government would be at a huge disadvantage in resolving cases and returning money to our healthcare system.”

“Our client, Ms. Siwicki, is a certified cardiovascular technologist who loved her career,” Young said. “Immediately after being hired by the defendant, she witnessed suspicious and unusual practices. Without people like Ms. Siwicki who bravely step forward to report bad practices, these types of schemes would continue unchecked for years on end.”

With Siwicki’s help, the team was able to provide numerous patient examples of falsified records to support increased billing for unnecessary cardiac ultrasounds, carotid artery ultrasounds, renal ultrasounds, and lower extremity arterial ultrasound Doppler studies, according to Young.

Siwicki filed the lawsuit under the whistleblower provision of the False Claims Act, which allows individuals to sue on behalf of the federal government over false and fraudulent claims and allows them to share in the recovered funds. The law also allows the government to intervene in a suit and take over the case, which it did here solely for purposes of settlement.

“This case exposes the fundamental flaw in our healthcare reimbursement system — it relies on the trust and integrity of physicians to bill for necessary and appropriate services and no more,” Young said. “The government cannot watch or audit every physician.”

The settlement with the federal government resolves the lawsuit’s claims.

If you or someone you know has witnessed fraud and is interested in helping to effect change, contact our whistleblower attorneys today for a free, no-risk, and confidential case evaluation. The team is ready to help you.