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False Claims Act Litigation
Sinaiko Healthcare Consulting, Inc. was retained by one of the world's largest law firms to conduct an investigation of alleged Medicare billing fraud in a civil matter related to the False Claims Act and physician billing issues. The assignment was particularly interesting because the law firm did not have a designated Health Care practice group; as a result, the Sinaiko consulting team was also charged with providing counsel to the firm's litigators regarding industry standards and practices. In addition, the lead consultant for the project (Jeff Sinaiko) was retained as an expert to testify on behalf of the client.
The Sinaiko team immediately engaged the assistance of computer software experts
with specific expertise in the billing systems involved in the dispute. After
successfully extracting the data needed for their investigation, a team of six
Sinaiko consultants organized the data and reviewed a sample of approximately
6,000 billing accounts, carefully evaluating them on a claim - by - claim, line-item
by line-item basis. At the conclusion of the investigation, Sinaiko issued
an Expert's Report, summarizing our findings of improprieties in the billing
records and confirming the appearance of fraudulent acts.
As the litigation progressed, the Sinaiko consultants spent extensive time offering industry expertise and counsel to the law firm's litigation team, whose members had little prior knowledge and experience with healthcare matters. Finally, Mr. Sinaiko was deposed and subsequently testified at trial in federal court.
The outcome of this engagement was positive for Sinaiko's client. At trial, the client was victorious on virtually all counts of the litigation. One of the counts was successfully appealed and ordered for re - trial, but was later settled on favorable terms for the client.
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