Healthcare Fraud

Healthcare Fraud

Our nations’ federal and state governments annually spend hundreds of billions of taxpayer dollars on government funded healthcare and prescriptions drug programs. These vast sums provide needed healthcare access to the most vulnerable in our communities. The funding for these programs comes straight from the pockets of hardworking citizens. When a doctor or medical facility acts fraudulently with these resources, it ultimately hurts the public more than the government, as they’re the ones who will ultimately pay the price through their own tax dollars. Unfortunately, healthcare fraud is the most commonplace fraud, but that doesn’t mean we have to stand idly while it occurs.

In fact, under federal and state False Claims Act (FCA) statutes, ordinary citizens can file whistleblower/qui tam lawsuits in federal and state courts. These lawsuits are intended to give the government information and evidence of the fraud. If the government successfully pursues and recovers monies from the defendants named in the lawsuits, the whistleblower may be entitled between 15-30% of all the monies the government recovers. 

Healthcare Fraud

Who Can Blow the Whistle on Hospitals, Doctors Offices, and Other Medical Facilities?

In many cases, medical facilities that are committing fraud will conceal their wrongdoing from the public and behind closed doors. Anyone within or outside the organization who has knowledge of overbilling, the payment of illegal kickbacks, or any other fraudulent activity can file a lawsuit on behalf of the government, such as:

Hospital, nursing home & hospice administrators
Hospital, nursing home & hospice administrators
Doctors, nurses, and physician assistants
Doctors, nurses, and physician assistants
Benefit administrators
Benefit administrators
Accountants
Accountants
Benefit consultants
Benefit consultants
Medical billing specialists
Medical billing specialists
Medical coding specialists
Medical coding specialists
Coding supervisors
Coding supervisors

Whistleblowers tend to be apprehensive about coming forward and volunteering information regarding fraud in the workplace. This concern is based upon the fear of facing retaliation from their employer. However, the federal and state laws contain provisions that provide qualified whistleblowers with legal remedies if they experience retaliation from their employer. Our experienced attorneys will guide you throughout this process and ensure your legal options are protected.

Qui Tam Lawsuites: Types of Fraud

Phantom Billing

Billing for Unnecessary Services

Kickbacks

Up-Coding

Unbundling

Double Billing

Waiving Co-Pays

Substitution of Generic Drugs

Noncompliance with FDA Regulations

Knowingly Providing Defective Medical Products or Services