A Healthcare Fraud Lawyer Can Help
Healthcare fraud in America exceeds $100 billion each year.
Whistleblower complaints are the single most important tool we have for detecting and preventing healthcare fraud. Under the federal False Claims Act, 31 U.S.C. 3729 (FCA), private citizens, also known as relators, can file qui tam lawsuits for healthcare fraud committed against the government.
Healthcare fraud hurts everyone, especially the poor and elderly who are denied critical services.
The most common types of healthcare fraud claims involve the following government programs:
- Medicare, which is a federal healthcare program providing insurance and healthcare services to individuals aged 65 and over, and those with certain disabilities and conditions
- Medicaid, which is a joint federal-state healthcare program providing need-based insurance and healthcare services to low-income individuals, including the aged, blind, and disabled
- TRICARE, which is a military healthcare program operated by the U.S. Department of Defense, formerly known as "CHAMPUS," providing healthcare benefits and services to uniformed service members, retirees, and their families
Successful healthcare fraud claims can garner substantial rewards.
Under the federal False Claims Act, healthcare fraud whistleblowers can receive a whistleblower reward that equals 15% to 30% of the government's total recovery. To date, healthcare fraud whistleblowers have helped the government recover over $15 billion.
If you are thinking about blowing the whistle on healthcare fraud and abuse, you should immediately speak with an experienced healthcare fraud lawyer. Our healthcare fraud lawyers provide assistance to whistleblowers across the United States.
Do I Have a Good Healthcare Fraud Case?
The first thing our healthcare fraud attorneys do is determine if you have a good case.
Good healthcare fraud cases have well-documented evidence of Medicare fraud, Medicaid fraud, or TRICARE fraud.
Good healthcare fraud cases also have whistleblowers with direct and independent knowledge of actual fraudulent activity. These insiders are often employees, contractors, agents, or industry experts.
Healthcare fraud whistleblowers generally fall into one of three categories:
- Medical Professionals, including nurses, physicians, pharmacists, researchers, and sales representatives
- Healthcare Professionals, including healthcare administrators, hospital administrators, and other licensed or certified health care professionals
- Financial Professionals, including accountants, benefit coordinators, coding specialists, and financial officers
Healthcare fraud schemes can vary from the simple submission of a false claim for reimbursement to complex schemes involving the submission of health care cost report manipulations, which contain thousands of pages of hospital overhead costs, capital improvement costs, and financing costs.
Medical billing fraud is perhaps the most common healthcare fraud scheme.
Billing code fraud involves the manipulation or alteration of a set of specific billing codes that Medicare and Medicaid require medical providers to use when they submit claims for payment to the government.
There are numerous variations and examples of healthcare billing fraud. The four most common include:
- Double Billing, which involves billing more than once for the same goods or services
- Mischarging, which involves billing for unnecessary medical procedures, tests, work, or services that are not delivered to patients
- Unbundling, which involves billing more by charging for individual tests and procedures where regulations require that such services be bundled together
- Upcoding, which involves billing more by falsely stating the existence of more expensive illnesses, medical treatments, or services
Discovering suspected medical fraud may be the easiest part of your whistleblower claim.
However, a successful healthcare fraud claim must follow a complex set of rules and procedures. If you don't follow the rules and procedures, you can lose your right to bring your claim. You can lose your right to collect any reward.
Having an experienced healthcare fraud lawyer on your side can make the difference between winning and losing your whistleblower case.
Choosing the Right Healthcare Fraud Attorneys Can Make All the Difference
To win your healthcare fraud case you must be able to identify and understand the various schemes that are used to defraud our healthcare system. Our legal team's knowledge and experience give you an advantage.
There are many schemes that healthcare companies use to fraudulently obtain increased Medicare and Medicaid reimbursements. Two of the most well-known involve off-label marketing and healthcare kickbacks.
Off-label marketing is a type of pharmaceutical fraud. Off-label marketing occurs when a pharmaceutical company markets or promotes a drug for a use without approval from the Food and Drug Administration (FDA).
Doctors can prescribe a drug for an off-label use. However, a pharmaceutical company generally cannot promote an off-label use. It is a violation of the False Claims Act for pharmaceutical companies to encourage physicians to use drugs billed to the government in an off-label manner.
Healthcare kickbacks involve the making of improper payments to induce the referral of patients or healthcare products payable by a federally-funded health care program. There are two laws that prohibit the use of kickbacks in the medical field:
- The Anti-Kickback Statute (AKS) is a federal criminal statute that prohibits anyone, including pharmaceutical companies, from making payments or using other inducements to influence the referral of patients or services covered by a federal or state health care program.
- The Stark Law (or Stark Statute), is a federal civil statute that prohibits physicians from referring Medicare or Medicaid patients to other entities when the physician or an immediate family member of the physician has a direct or indirect financial relationship with the entity.
These laws are complicated and the requirements for filing a lawsuit can be daunting. That's why you need to choose the right healthcare fraud attorneys to help you make and win your case.
In addition to complicated filing procedures, healthcare whistleblower cases have short deadlines. If you do not follow these deadlines, your case can be thrown out of court.
If you discover healthcare fraud, you need to come forward with the information as soon as possible. Acting promptly is critical if you want to receive whistleblower protection. It is also the key to maximizing your whistleblower reward.