Whistleblower Lawsuits and Healthcare Fraud

The lawyers and attorneys at our firm have helped individuals seeking to expose fraud and waste in government healthcare programs, including Medicare and Medicaid, file Whistleblower lawsuits. Medicare and Medicaid fraud is the most common type of healthcare fraud that is covered by Whistleblower laws. One estimate states that fraud and abuse cost Medicare and Medicaid about $33 billion each year. In fiscal year 2001 alone, the Department of Justice reported recoveries of more than $1.2 billion related to civil health care fraud. However, the government was only able to recover a small portion of the estimated fraud.

The Medicare program was projected to spend $327 billion in federal fiscal year 2006. The program, which serves about 42 million people, has been expanded to include an outpatient prescription drug benefit reflecting a new commitment of some $1.2 trillion in federal spending over the next decade. Thus, both taxpayers and Medicare beneficiaries have enormous financial exposure under Medicare.

With all of this money in the program, the temptation to commit fraud is significant. Often, Whistleblower lawsuits are the only way that this type of fraud is uncovered. Because these cases are so complicated, it is important that individuals retain an experienced Whistleblower lawsuit lawyer before proceeding.

Medicare and the False Claims Act

The Department of Justice considers Medicare fraud to be one its top enforcement priorities and frequently utilizes the False Claim Act to punish violators and seek recoveries. The False Claims Act provides that anyone who “knowingly” submits false claims to the government is liable for damages up to three times the amount of the erroneous payment plus mandatory penalties between $5,500 and $11,000 for each false claim submitted. These penalties can quickly add up in a Medicare or Medicaid situation, where healthcare providers submit thousands of claims annually. Our Whistleblower lawyers have a vast amount of experience with the False Claims Act as it pertains to Medicare fraud, and we can make sure your rights are protected should you want to expose such a crime.

The problem of Medicare fraud and healthcare fraud in general has reached epidemic proportions. The United States General Accounting Office estimates that medical fraud and abuse approaches 10% of all health care expenditures. This mean fraudulent billing can reach $100 billion per year. According to a report by the Department of Health and Human Services, a grand total of $136,756,946 was awarded to Whistleblowers who filed healthcare fraud Qui Tam lawsuits on behalf of the Federal government under the False Claims Act. If you are aware of instances of Medicare, only an experienced Whistleblower lawyer can make sure that your rights are protected.

The False Claims Act and its Whistleblower provisions have been particularly effective in the fight against Medicare fraud. In studies conducted for Taxpayers Against Fraud (TAF) in 2001, 2003, and 2005, it was found that the return on anti-fraud efforts has been rising-from about $8 for every $1 invested in health-related False Claims Act enforcement activities, to $13. By far, the most significant portion of the government’s recoveries were attributable to False Claims Act cases.

Whistleblower Lawsuits Involving Fraudulent Billing

Qui Tam claims can be filed against any of the following providers who fraudulently bill Medicare or Medicaid:

  • Physicians
  • Hospitals
  • Laboratories
  • Testing Facilities
  • Medical Device Manufacturers
  • Pharmaceutical Manufacturers

There are various ways that fraudulent billing can occur For example, a provider may charge for legitimate goods or services provided at an unreasonable rate. Providers cannot take advantage of an oversight by the government by charging exorbitant prices. Providers are also prohibited from conspiring with another to pay high rates for its services (whereby one makes money off of the contract while the other reaps higher government reimbursement). Our Whistleblower lawsuit lawyers can help determine if your situation meets the criteria for healthcare fraud under the federal False Claims Act.

Other Types of Healthcare Fraud

There are other types of healthcare fraud that may also fall under the Whistleblower provisions of the False Claims Act. For example, kickbacks, or hidden financial arrangements between various health care providers in order to insure that one provider uses the services of the other are often illegal. Health care providers who submit Medicare and Medicaid claims containing false statements also may be liable under the False Claims Act.

Federal and state governments fund a variety of research and other specialized projects in the healthcare area. Typically, government funds are targeted for a specific and narrow purpose, a specialized research project or medical care for a specific group. Sometimes the recipients of grant or program funds mischaracterize their qualifications, the basis of their research or the quality and extent of services they provide. This type of fraud is also actionable under the False Claims Act.

There are many other types of healthcare fraud that fall under the False Claims Act. The best way to determine if an incident meets the definition of fraud under the False Claims Act is to speak with an experienced Whistleblower lawyer.

Legal Help & Free Case Evaluation

If you are thinking of coming forward and blowing the whistle on your employer or another company, please fill out the form on our Free Consultation page today! Our lawyers will evaluate your case confidentially and at no cost.

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