There has been a tremendous amount of activity around the country involving health care fraud with much of the wrongdoing involving claims under the False Claims Act (FCA). I will give a brief summary of whistleblower litigation involving health care and will discuss Medicaid and Medicare fraud in more detail in this Section of the report.
Health care fraud involves the filing of dishonest health care claims in order to turn a profit. Some examples of “practitioner schemes” include a health care provider who bills Medicare for services that were not performed or were unnecessary, double-billing, billing for a non-covered service as a covered service, modifying medical records, intentionally reporting incorrect diagnoses in order to maximize payment, and prescribing unnecessary treatment. All of these hurt the government, taxpayers and persons who qualify for Medicare and Medicaid.
The False Claims Act holds responsible those who knowingly submit, or cause another entity or person to submit, false claims for payment of government funds. Those found responsible for fraud are liable for three times the government’s damages, plus civil penalties of $5,500 to $11,000 per false claim. Whistleblower provisions included in the False Claims Act allow citizens with evidence of fraud against government contractors and programs to sue, on behalf of the government, to recover the stolen funds. The whistleblower is then eligible to receive a portion of the recovered funds, usually between 15 and 25 percent.
In addition to the federal False Claims Act, many states also have False Claims Acts that work in a similar fashion. There also is a part of the False Claims Act that is known as the “whistleblower protection” provision. This provision ensures that if you are fired, demoted, suspended, threatened or discriminated against in any other way by an employer as a result of your filing a report of fraud, that you will be reinstated to your former position. This includes receiving any seniority that may have been affected, as well as back pay, interest and other compensation that may be due as a result of damages or losses you suffered as a result of filing a claim.
I have attempted to give a brief explanation of health care fraud that gives rise to whistleblower claims. If you feel you have such a claim, the lawyers on our firm’s Whistleblower Litigation Team will be glad to talk with you. You may be entitled to compensation. Contact Michelle Fulmer, Section Administrator, at 800-898-2034 or by email at Michelle.Fulmer@beasleyallen.com, and she will put you in touch with a lawyer on the team.
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