Posted on June 29, 2013 in Whistleblower Litigation
The government pays large rewards to individuals who help it uncover Medicare and Medicaid fraud. In many cases, the whistleblower rewards amount to hundreds of thousands of dollars, and often the government pays millions of dollars to the individual who helped stop the fraud.
Becoming a whistleblower also gives you significant legal protections. Sooner or later, the Medicare or Medicaid fraud will be discovered by the government. If you say nothing now, you could find yourself in handcuffs talking to FBI agents when they discover the fraud. Coming forward with evidence before the government discovers the fraud can help you avoid criminal prosecution.
Here is how the whistleblowing process works under the False Claims Act. First, you must consult with an experienced whistleblower attorney to find out if you have a case. The consultation is free and completely confidential. The lawyer will assess your case and tell you whether or not it is worthwhile pursuing.
If you have a case, your lawyer will work with you to pull together your evidence of false claims or fraud. He will file a complaint in court "under seal" (in secret) and will present your evidence in secret to a government prosecutor. The prosecutor will then investigate the false claims and decide whether to pursue legal action.
If the government pursues the case and wins, then you will be entitled to between 15% and 25% of the amount the government recovers. If the government decides not to pursue the case, then you and your lawyer can decide to pursue the case on your own. In that event, you will receive between 25% and 30% of the amount recovered as your whistleblower reward.
You do not have to pay your whistleblower attorney any legal fees unless you win, in which case your attorney will be paid a percentage of your reward.
What constitutes Medicare and Medicaid fraud? The list is very long, and it includes every type of false claim submitted to the government. Here are just a few of the most common types of Medicare and Medicaid fraud cases that result in large whistleblower rewards:
Ambulance Fraud includes billing Medicaid to transport dialysis patients by ambulance when they could be transported by wheelchair van instead because they can walk or sit in a wheelchair. Ambulance fraud also includes Billing for patients who do not have valid Physician Certification Statements (PCSs), altering or creating false PCSs, trip reports or patient records, billing for trips that never happened, and billing for more miles than actually traveled.
Coding Violations include any instance when an improper billing code is used to receive a higher reimbursement rate from Medicaid or Medicare than the service justifies. Coding violations include: Upcoding (using a higher value code than the service justifies); Unbundling (billing separately for services that should be billed together under one code); and Double-Billing (billing Medicare and private insurance for the same service, or billing once for services using a bundled code and then billing again for part of the services using another code).
Dental Fraud includes billing Medicare or Medicaid for services that were not medically necessary or were not actually provided. Fraud by dentists also includes splitting claims or billing for multiple office visits when the work was done on a single visit.
Durable Medical Equipment Fraud includes prescribing or billing for DME that was not medically necessary or was not actually provided to the patient. DME Fraud also includes billing for more expensive equipment than was actually provided to the patient, such as billing for a high-end power wheelchair when the patient received a less expensive product.
Home Health Care Fraud includes billing for services that were not provided, billing more time than was actually provided, and billing for services that were not medically necessary. Home Health Care Fraud also includes billing for a more-experienced professional when a less-experienced person actually provided the service, such as when a company claims reimbursement for a Registered Nurse (RN) when a Licensed Practical Nurse (LPN) provided the services, or when a company claims reimbursement for a Physical Therapist (PT) when a Massage Therapist provided the services.
Kickbacks include paying or receiving anything of value in return for patient referrals or in return for prescribing treatments or equipment that will be paid for by Medicare or Medicaid. Kickbacks are not limited to cash payments. Anything of value can be a kickback, including expensive dinners, tickets to concerts or sporting events, trips, low-cost office space, etc.
Pharmacy Fraud includes billing for drugs that were never dispensed to the patient, billing for a higher-priced branded drug when the patient was given a lower-priced generic, and billing for controlled substances that are being diverted.
Physician Self-Referrals occur when a physician refers patients to certain health care businesses in which the physician or a member of his immediate family has a financial interest. A financial interest includes an ownership interest, an investment interest, or a compensation arrangement. It also includes non-cash arrangements, such as when a hospital provides free staff or below-market rent to a physician who refers patients to the hospital.
If you are aware of these or any other types of false claims involving Medicare or Medicaid, then you should consult with an experienced whistleblower attorney immediately. You may be entitled to legal protections and a large reward.
To arrange a free and confidential consultation with an experienced whistleblower attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our office by email.
Do not delay. To get legal protection as a whistleblower, you must go to the government with your attorney before the government comes looking for you.
The government pays large rewards to individuals who help it uncover
Medicare and Medicaid fraud. In many cases, the whistleblower rewards
amount to hundreds of thousands of dollars, and sometimes the reward is
in the millions of dollars.