September 17, 2015
U.S. ex rel. Laura Lovett and Lisa Mayhew v. Holzer Clinic
In this qui tam lawsuit, the plaintiffs alleged that their former employer, a medical provider, had a widespread practice of upcoding various patient services and submitting false claims to federally-funded medical coverage programs, including Medicare and Medicaid.
Econ One was retained by counsel for the plaintiffs to: (1) select a random sample of patients; and (2) based on a medical expert’s analysis of this sample, extrapolate the number of false claims and amounts ineligible for reimbursement. Dr. Brian Kriegler submitted an expert report in which he discussed the sampling design and various damages calculations. The case settled prior to trial.