Whistleblower Lawsuits and the Anti-Kickback Statute

Whistleblower Lawsuits and the Anti-Kickback Statute

Whistleblower Lawsuits and the Anti-Kickback Statute


Whistleblowers can file qui tam lawsuits under the False Claims act when they have knowledge of fraud. These cases are filed on behalf of the government. If their case is successful, the whistleblower can receive a share of the recovered funds. Healthcare fraud is one of the most common types of cases brought by whistleblowers, who may uncover a variety of illegal and fraudulent activities. In these cases, allegedly dishonest parties take advantage of federally-sponsored healthcare programs such as Medicare and Medicaid. In order to discourage this type of fraud, the Anti-Kickback Statute was put into place.

The purpose of the Anti-Kickback Statute is to prevent situations where a healthcare provider selects or recommends medical goods and services that are reimbursed through Medicare and Medicaid due to financial incentives. Under this statute, no person or entity can accept payment to refer, recommend or provide medical goods or services that are reimbursable through federally funded programs. The statute states that both parties are liable. Healthcare providers who participate in federal healthcare programs such as Medicare, Medicaid, CHAMPUS/TRICARE, CHAMPVA, Federal Employee Health Benefit Program and others are required to comply with the Anti-Kickback statute.

Parker Waichman LLP provides free legal consultations to individuals who want to file a whistleblower lawsuit. If you have knowledge of fraud or are aware of violations of the Anti-Kickback Statute and want more information about your legal rights, contact our firm today.

The Stark Law is a separate but related law that says physicians cannot refer patients for services that are paid for by federally-funded programs if they have a financial relationship with the referred party. The Anti-Kickback Statue and the Stark Law are ways in which the government tries to prevent healthcare fraud. If healthcare professionals accept kickbacks for goods or services that federal programs pay for, it causes the government to be overcharged and can put patients at risk for services that are unnecessary and perhaps even harmful.

While these laws are in place, it is often difficult for the government to enforce compliance due to inadequate staffing and lack of resources. Because of this, whistleblowers can play a critical role by reporting parties that are defrauding federally-funded healthcare programs by violating the Anti-Kickback Statute.

As an example, the federal government filed a false claims lawsuit against Liberty Ambulance Services, Inc. alleging that the company submitted false claims and engaged in a systematic kickback scheme for a decade. The case stemmed from a whistleblower lawsuit filed by a former employee. According to News4Jax, the lawsuit alleges that Liberty Ambulance offers absurdly low prices to private payors such as hospitals and nursing homes while failing to offer these same discounts to the government. The company does this so that the payors will provide them with sole access to their federally-subsidized patient population, the government alleges. As a result, Liberty Ambulance allegedly caused false claims to be submitted in order to maximize reimbursement.

According to the lawsuit, the company provided training documents and materials instructing employees to falsify records. Allegedly, management created a culture where false claims were knowingly submitted in order to warrant ambulance transports that were unnecessary. The government alleges that $28 million in claims were submitted because of these actions, and the vast majority of them were actually non-reimbursable because they were medically unnecessary or based on false statements. The U.S. Department of Health and Human Services, Office of Inspector General, the Federal Bureau of Investigation, and the Office of Personnel Management investigated the case, which is being handled by Assistant United States Attorney Jason Mehta.

Whistleblowers have been valuable in detecting fraud and subsequently saving the government and taxpayers money. If you or someone you know wants to file a whistleblower lawsuit through the False Claims Act or simply want more information, contact Parker Waichman LLP today.

Free Case Review