The federal False Claims Act and state law equivalents are important tools in the fight against waste, fraud, and abuse of taxpayer money. Persons with knowledge of fraud against government programs and contracts can file qui tam lawsuits on behalf of the government to recover taxpayer money. In addition, there may be substantial rewards for those who report fraudulent conduct. In fact, Congress has strengthened the Act by increasing incentives for people to file lawsuits on behalf of the government. And a recent U.S. Supreme Court decision has made it easier to file these lawsuits.
If you're afraid of an employer, business partner, or other person or entity punishing you for reporting fraud, know that the False Claims Act can also provide significant financial rewards if others retaliate against you for providing information. No one should make you feel afraid to do the right thing.
Qui tam lawsuits are increasingly common, and settlements and recoveries have been growing quickly. In 2016 alone, the U.S. reported that it had recovered over $4.7 billion from False Claims Act cases. From 2009 through 2016, the total amount recovered has been over $31.3 billion.
Of the $4.7 billion recovered by the US in 2016, over half came from the healthcare industry, including drug companies, medical device companies, hospitals, nursing homes, labs, and physicians. These recoveries restore money to programs such as Medicare and Medicaid. But just as important, the vigorous pursuit of health care fraud prevents billions more in losses by deterring others who might try to cheat the system.
Examples of Healthcare Fraud
These are examples of Healthcare Fraud that you should report to the McAllen Whistleblower Lawyer at Omar Ochoa Law Firm:
- Selling defective medical devices.
- Billing for a service not provided to the patient.
- Billing for a procedure or product the patient didn’t need. For example, a patient only needs a basic x-ray which costs $75, but the physician orders an MRI and related testing.
- “Up coding”, i.e. using a billing code that has a higher reimbursement rate than the procedure actually performed.
- Giving or receiving money, gifts, trips, meals, or other things of value in exchange for referrals or business.
- Physicians referring patients to other businesses they own. For example, a doctor may not refer one of his patients to a physical therapy business that the doctor also owns.
- Simultaneous procedures. For example, if a surgeon begins a procedure on one patient, he cannot leave to start a procedure on another patient before finishing the first procedure.
- Medical procedures performed by unqualified staff. For example, a surgical assistant cannot insert implants into a patient or make cuts to the patient.
- Misrepresenting patient data. For example, wrongly reporting a patient’s age or address.
- Pharmacies providing partially full prescriptions
Whistleblowers have recovered millions of dollars as a result of working with an attorney to file lawsuits for healthcare fraud:
- Damon Clinical Laboratories, Inc. bundled medically unnecessary tests. The Government recovered $83.7 million and three whistleblowers recovered over $9 million.
- Blue Cross Blue Shield of Michigan backdated documents in response to a government audit and paid $27.6 million. The whistleblower was rewarded $5.5 million.
- Physicians at a Tenet hospital in California were performing unnecessary cardiac procedures, resulting in a fine of $54 million. Two whistleblowers received $8.1 million.
We've worked with Whistleblowers to recover millions of dollars from healthcare facilities and practitioners who were committing healthcare fraud. Healthcare fraud cases are complicated and expensive, but the Whistleblower Attorney at Omar Ochoa Law Firm PC in McAllen has the resources, experience, and knowledge to pursue maximum recovery. Contact us for a consultation. We will keep your identity and information confidential.