The Greenville News recently published a story about a different kind of hero–Dr. Michael Mayes. Since 2010, he’s worked mostly in secret to gather information, turn it over to the government and help build a federal case to expose national Medicare fraud that affected his own patients on Hilton Head — and those around South Carolina and the nation too. If Mayes hadn’t risked his career, relationships with fellow physicians and future job prospects, the fraud could still be going on today.
His work exposed a national scam where physicians ordered panels of lab tests that were not medically necessary for their patients and received illegal kickbacks. As a result, Medicare, and other government healthcare programs, paid upward of $500 million in fraudulent claims. Mayes’ whistleblower lawsuit, the first of three, was filed under seal in 2011 and later taken over by the federal government. His name was not revealed until 2015 when the first settlement in the case was announced.
He was the only physician to come forward. The taxpayers of South Carolina owe him a debt for his courage and integrity.
The federal anti-kickback statute, which prohibits laboratories from “offering or paying any renumeration, in cash or kind, directly or indirectly, to induce or influence physicians” to order tests that “may be paid for by federal health care programs,” according to the federal complaint.
In June 2011, a lawsuit was filed alleging Berkeley, BlueWave Healthcare Consultants and LipoScience “routinely” paid kickbacks to physicians to convince them to order tests. LipoScience was later dropped from the suit, because what it had done was “significantly less egregious” than the others. Later, Health Diagnostic Laboratory, Singulex and Quest Diagnostics — a company that purchased Berkeley in 2011 — were added to the suit.
In January 2012, Quest Diagnostics decided to stop offering the payments to physicians. When the payments stopped, Mayes noticed physicians stopped ordering the tests.
“Once they stopped paying for the tests, the number of tests ordered was drastically reduced,” Gaudette said. “In my opinion, money had a lot to do with it.”
According to the federal complaint, Quest then tried to get doctors to continue ordering the tests by offering to pay phlebotomists’ salaries and leasing office space from the practices, among other things. One cardiologist said his practice was bringing in $17,000 a month by ordering the tests, or about $200,000 a year.
In June 2014, the Office of Inspector General issued a special fraud alert about these payments to physicians.
In 2015, Health Diagnostic Laboratory and Singulex agreed to pay $48.5 million to settle claims that they violated the False Claims Act.
And in 2016, Quest Diagnostics agreed to pay $6 million to settle the same allegations.
Mayes testified as a witness for the government — the only whistleblower to do so — in January 2018 in Charleston. Three individuals associated with Health Diagnostic Laboratory and BlueWave chose not to settle and were tried by jury. The jury sided with the government after the two-week trial. In May, a $114 million judgment against the three was announced.
Health Diagnostic Laboratory filed for bankruptcy, and trustees have since filed suit against individual physicians who received a “significant” amount of money from the kickbacks, Mayes said.
Mayes, and the other whistleblowers, helped put an end to the scheme. Part of choosing to talk about the case, Mayes said, is because he believes patients should be aware of fraud, and those who commit it should be held responsible.
According to Medicare.gov, here are a few precautions patients can take to protect themselves from fraud:
▪ Save dates, receipts and statements for healthcare services you receive.
▪ Compare your records with statements from Medicare to make sure the services and dates match up. If those records don’t match, it’s possible Medicare was billed for services you didn’t receive.
▪ If a charge seems incorrect, call the provider’s office to inquire about it.
▪ If you suspect there is Medicare fraud, report it online or by calling 1-800-633-4227.