BOTOX “MATH”

You may have heard of an event called a “Botox party”. The basic concept is that a group of people get together and “share” a vial of Botox to address signs of age which may appear on a person’s face. These “events” are paid for individually and do not in any way utilize taxpayer dollars.

 

Dr. Raymond Brown of Cleveland, Tennessee has now reinvented the “Botox party”. Unfortunately for him, the party will now result in 20 months in prison and the forfeiture of $6 million as reimbursement for fake billing.

 

Dr. Brown set a record for billing Medicare for the most Botox injections. The doctor billed Medicare for 17,000 vials of Botox in one year. The math didn’t work for a number of reasons. Reason one: Cleveland, Tennessee has about 41,000 residents. The doctor would have had to inject one out of three residents of the entire city to get to this number. Reason two: the doctor would have to see one patient every 15 minutes, 10 hours per day for six days a week and he still would not have used the entirety of the 17,000 vials billed to Medicare. Reason three: when the search warrant was executed, the inspectors determined that the doctor had in fact only purchased 254 vials of Botox.

 

This type of Medicare fraud is, unfortunately, not unusual. There are a number of ways that the fraud can occur. The doctor may bill for services that were never performed as it appears was the case in the Brown matter. Alternatively, the doctor can charge for the vial when it is in fact not used in its entirety. And, with a profit motive, doctors and other medical providers are coming up with new and unique ways to defraud the government every day.

 

It is not clear whether or not this fraud was brought to the attention of the United States government by a whistleblower or a “relator”. However, if a relator brought the information to the attention of the federal government, they would have been entitled to between 15% and 30% of the monies recovered by the United States government. Relators, folks who bring fraud to the attention of the United States or state governments, are rewarded under the applicable statutes for providing information the government may not otherwise be able to obtain. The incentive program is working. Many matters which the United States government or a state government might not otherwise ferret out are being brought to the attention of the government on a regular basis due to the incentive program.

 

If you are aware of a Medicare fraud such as the above or, for that matter, any fraud where the United States government or a state having a False Claims Act is being defrauded, you should contact a qualified whistleblower attorney.