Hospital
administrators, nursing home administrators,
doctors, coders, benefit coordinators, nurses, chief
financial officers, and other health care
professionals have been stepping up and blowing the
whistle on health care fraud that costs taxpayers
about $100 billion each year including Medicare
fraud, Tricare fraud, Hospice fraud, and other types
of fraud. These health care fraud whistleblowers
are American Heroes that have knowledge of false and
illegal billing practices, and have had the strength
& integrity to file Qui Tam Whistle Blower Actions.
The result of these health care professionals has
been recovery of hundreds of millions of dollars
that have been stolen from Medicare, Tricare, and
Medicaid as well as improvements in preventing
future health care fraud which helps all Americans.
As more often Health Care
Administrators, Hospital Administrators, Nursing
Home Administrators, Doctors, Coders, Benefit
Coordinators, Nurses, Chief Financial Officers, and
other health care professionals become aware of
fraudulent billing practices they are stepping up to
make our health system more efficient and better for
all and at the same type eliminating corruption.
Medicare Fraud, Medicaid
Fraud, Tricare
Fraud, Nursing Home Fraud, Hospice Fraud, are all
forms of
Health Care Fraud that Can Be the Basis for Qui Tam Lawsuits
and other Whistleblower Reward Lawsuits
Law enforcement authorities
estimate that health-care fraud costs taxpayers
between $60 billion and $100 billion each year.
Each year the government reimburses approximately
$40 billion in payments to nursing homes and $4
billion in payments to various providers of medical
supplies and services for Medicare beneficiaries
residing in nursing homes. The United States General
Accounting Office estimates that $1 out of every $7
spent on Medicare is lost to fraud and abuse.
These numbers are expected to
greatly increase as more and more people become
eligible for Medicare, VA Benefits, and Tricare.
Through Medicare Fraud, Tricare Fraud, Nursing Home
Fraud, Hospice Fraud, and other Health Care Fraud
Qui Tam Claim Lawsuits billions of dollars are
expected to be recovered from individuals and
organizations that have committed health care fraud
on the United States Government and State
Governments.
Health care fraud costs United
States Tax Payers large amounts of money through
Medicare, Medicaid, Tricare, and other government
health care programs. A critical aspect of the
Health Care Fraud problem is that Medicare, the
health program for the elderly and the disabled,
automatically pays the vast majority of the bills it
receives from companies that possess federally
issued supplier numbers. Computer and audit systems
now in place to detect problems generally focus on
over billing and unorthodox medical treatment rather
than fraud. Therefore, without experienced Health
Care Administrators, Hospital Administrators,
Nursing Home Administrators, Doctors, Coders,
Benefit Coordinators, Nurses, Chief Financial
Officers, and other health care professionals, it
can be extremely difficult to determine when
upcoding and mischarging for services is occuring.
Medicare Fraud, Tricare
Fraud, Nursing Home Fraud, Hospice Fraud, and other
Health Care Fraud are in the News as Whistleblowers
and Government Agents Strike Back Against Health
Care Fraud
The Department of Justice has
been cracking down on Fraud and False Claims
including Medicare Fraud, Tricare Fraud, Nursing
Home Fraud, Hospice Fraud, and other Health Care
Fraud. Below is an update on recent Department of
Justice recoveries.
Pfizer to pay record $2.3B
penalty over promotions Repeat offender Pfizer
paying record $2.3B settlement for illegal drug
promotions By Devlin Barrett, Associated Press
Writer On Wednesday September 2, 2009, 3:47 pm EDT
"WASHINGTON (AP) -- Federal
prosecutors hit Pfizer Inc. with a record-breaking
$2.3 billion in fines Wednesday and called the
world's largest drug maker a repeating corporate
cheat for illegal drug promotions that plied doctors
with free golf, massages, and resort junkets."
Announcing the penalty as a
warning to all drug manufacturers, Justice
Department officials said the overall settlement is
the largest ever paid by a drug company for alleged
violations of federal drug rules, and the $1.2
billion criminal fine is the largest ever in any
U.S. criminal case. The total includes $1 billion in
civil penalties and a $100 million criminal
forfeiture.
More Than $1 Billion Recovered
by Justice Department in Fraud and False Claims in
Fiscal Year 2008
WASHINGTON – The United States
secured $1.34 billion in settlements and judgments
in the fiscal year ending Sept. 30, 2008, pursuing
allegations of fraud against the federal government,
the Justice Department announced today. This brings
total recoveries since 1986, when Congress
substantially strengthened the civil False Claims
Act, to more than $21 billion.
"Now, more than ever, it is
crucial that taxpayer dollars aren't lost to fraud,"
said Gregory G. Katsas, Assistant Attorney General
for the Department’s Civil Division. "The billion
dollars collected this year is only part of the
story. By rooting out fraud and vigorously pursuing
it, the Department, with the help of concerned
citizens who report fraud in hotline calls and in
qui tam complaints, undoubtedly saves the country
many times that amount in aborted schemes and
misconduct."
Assistant Attorney General Katsas
also paid tribute to Senator Charles Grassley of
Iowa and Representative Howard L. Berman of
California who sponsored the 1986 amendments to the
False Claims Act, the government's primary weapon to
fight government fraud. "Without this important
legislation strengthening the Act and, in
particular, the qui tam provisions which encourage
private citizens to uncover government fraud, such
recoveries would not have been possible."
Almost 78 percent of this year’s
recoveries are associated with suits initiated by
private citizens (known as "relators") under the
False Claims Act's qui tam provisions. These
provisions authorize relators to file suit on behalf
of the United States against those who have falsely
or fraudulently claimed federal funds. Such cases
run the gamut of federally funded programs from
Medicare and Medicaid to defense procurement
contracts, disaster assistance loans and
agricultural subsidies. Persons who knowingly make
false claims for federal funds are liable for three
times the government’s loss plus a civil penalty of
$5,500 to $11,000 for each claim.
Relators recover 15 to 25 percent
of the proceeds of a successful suit if the United
States intervenes in the qui tam action, and up to
30 percent if the government declines and the
relator pursues the action alone. In fiscal year
2008, relators were awarded $198 million. (This
figure does not include relator shares awarded after
Sept. 30, 2008.)
As in the last several years,
health care accounted for the lion's share of fraud
settlements and judgments–$1.12 billion. This number
includes both qui tam claims and those initiated by
the United States. The Department of Health and
Human Services reaped the biggest recoveries,
largely attributable to its Medicare program and the
federal/state Medicaid program which funds health
care for the needy. Recoveries were also made by the
Office of Personnel Management which administers the
Federal Employees Health Benefits Program, the
Department of Defense for its TRICARE insurance
program, the Department of Veterans Affairs and
others.
The largest health care
recoveries came from pharmaceutical companies and
related entities. Settlements with Cephalon Inc.,
Merck & Co. and CVS Caremark Corp. accounted for
more than $640 million. In addition to federal
recoveries, these pharmaceutical fraud cases
returned $430 million to state Medicaid programs.
The Civil Division’s
investigation of the pharmaceutical industry is part
of a Department-wide effort. Typical allegations
include "off-label" marketing, which is the illegal
promotion of drugs or devices that are billed to
Medicare and other federal health care programs, for
uses that were neither found safe and effective by
the Food and Drug Administration nor supported by
the medical literature; paying kickbacks to
physicians, wholesalers and pharmacies to induce
drug or device purchases; establishing inflated drug
prices knowing that federal health care programs use
these prices to reimburse providers, then marketing
the "spread" between the federal reimbursement and
the provider’s lower cost to induce drug purchases;
and knowingly failing to report the company’s true
"best price" for a drug to reduce rebates owed to
the Medicaid program.
The Department also collected
$133 million in defense procurement fraud. Defense
contract recoveries included a $53 million
settlement with Pratt & Whitney, a division of
United Technologies Corporation, and PCC Airfoils
LLC, a subsidiary of Precision Castparts
Corporation. The settlement resolved allegations
that Pratt & Whitney and PCC Airfoils knowingly
submitted false claims to the Air Force for
defective turbine blades sold to the government to
retrofit the F100-PW-220 engines in F-16 and F-15
aircraft. This case was pursued as part of a
National Procurement Fraud initiative, launched in
October 2006, to promote the early detection,
identification, prevention and prosecution of
procurement fraud.
FACT SHEET: SIGNIFICANT
RECOVERIES IN FISCAL YEAR 2008
Among the Department’s most
significant settlements and judgments in fiscal year
2008 were:
$361.5 million from Merck &
Company to resolve allegations that the
pharmaceutical manufacturer knowingly failed to pay
proper rebates to Medicaid and other government
health care programs, and paid kickbacks to health
care providers to induce them to prescribe the
company’s products. The settlement resulted from two
lawsuits brought under the qui tam provisions of the
False Claims Act.
In the first, which accounted for
$221.9 million of the $361.5 settlement, a former
Merck employee alleged that the company violated the
Medicaid Rebate Statute by providing deep discounts
to hospitals that used its drugs Zocor and Vioxx in
place of competitors’ brands, without reporting
those discounts and other cost information to
reflect its "best price," as required by the statute
to ensure that Medicaid obtains the benefit of the
same price concessions other purchasers enjoy. This
suit also alleged that Merck paid kickbacks to
physicians, disguised as fees for training,
consultation, and market research, to induce them to
prescribe its drugs, also contrary to law. The
United States paid the relator $46.6 million as his
share of the settlement under the False Claims Act’s
qui tam provisions. In addition to the federal
recovery, Merck paid $162 million to state Medicaid
programs.
In the second lawsuit, which
accounted for the remaining $139.6 million of the
settlement, a physician alleged that Merck provided
deep discounts to hospitals to induce them to
administer its antacid, Pepcid, as a means to boost
sales through continued use after the patient’s
discharge. The suit went on to allege, similar to
the first suit, that Merck knowingly failed to
report these discounts as required by the Medicaid
Rebate Statute, which resulted in illegal and
inflated claims to federal and state Medicaid
programs. In addition to paying the United States
$139.5 million in federal claims, Merck paid $114
million to settle state Medicaid claims. The relator
received $24 million as his federal share of the
settlement and an additional sum for the state
recoveries. Merck also entered into a Corporate
Integrity Agreement with the Inspector General of
the Department of Health and Human Services (HHS) to
ensure compliance with federal health insurance
programs in the future.
For the original press release,
see:
http://www.usdoj.gov/opa/pr/2008/February/08_civ_094.html
http://www.usdoj.gov/usao/pae/News/Pr/2008/feb/steinkrelease.pdf
$258 million from Cephalon Inc.
to resolve claims that the company marketed three
drugs for uses not approved by the Food and Drug
Administration (FDA). By promoting the drugs for
so-called "off label" uses, Cephalon caused
providers to charge federal health insurance
programs such as Medicare, Medicaid, TRICARE and the
Federal Employees Health Benefits Program for
unapproved uses of the drugs not covered by the
programs. The settlement resolved four lawsuits,
three of which were brought by former Cephalon sales
representatives under the qui tam provisions of the
False Claims Act. Consistent with those provisions,
the relators who filed the suits will share $46.7
million as their part of the settlement. In addition
to the $258 million recovered for federal programs,
the United States recovered $116 million for the
Medicaid programs in 14 states and the District of
Columbia. Cephalon also pleaded guilty to related
criminal charges, paid $50 million in fines and
forfeitures and entered into a five-year Corporate
Integrity Agreement with the Inspector General of
HHS to ensure strict compliance in the future.
For the original press release,
see:
http://www.usdoj.gov/opa/pr/2008/September/08-civ-860.html
$225 million from Amerigroup
Corporation to settle both federal and state
allegations that Amerigroup, together with its
Illinois subsidiary, systematically avoided
enrolling pregnant women and other high-cost
patients in the company’s managed care program in
Illinois. The program was funded by Medicaid, which
required open enrollment to all eligible
beneficiaries. By excluding pregnant women and other
high-cost patients, Amerigroup increased its profits
in conflict with the law. The United States and
Illinois jointly brought suit under the federal
False Claims Act and the Illinois Whistleblower
Reward and Protection Act. In October 2006,
following a lengthy trial, the court entered
judgment for $334 million. Amerigroup appealed and
the parties entered negotiations leading to
settlement. The relator received $56.25 million as
his share of the federal and state recoveries. In
conjunction with the settlement, Amerigroup entered
into a Corporate Integrity Agreement with the
Inspector General of HHS to ensure future
compliance.
For the original press release,
see:
http://www.usdoj.gov/opa/pr/2008/August/08-civ-723.html
$75 million to settle claims that
Kyphon Inc., now Medtronic Spine LLC, violated the
False Claims Act by knowingly causing the submission
of false claims to Medicare for its kyphoplasty
procedure–a minimally-invasive surgery used to treat
compression fractures of the spine. The settlement
resolved a lawsuit filed by two former Kyphon
employees under the qui tam provisions of the False
Claims Act. The suit alleged that Kyphon engaged in
a seven-year marketing scheme that resulted in
certain hospitals billing Medicare for kyphoplasties
performed on an inpatient basis rather than for less
costly and clinically appropriate outpatient
kyphoplasty treatment. This conduct resulted in the
Medicare program paying more for inpatient
kyphoplasty procedures. The relators received a
total of $14.9 million as their share of the
settlement. In conjunction with the settlement,
Kypon entered into a Corporate Integrity Agreement
with the Inspector General of HHS to ensure future
compliance.
For the original press release,
see:
http://www.usdoj.gov/opa/pr/2008/May/08-civ-455.html
$74 million from Staten Island
University Hospital (SIUH) to resolve two False
Claims Act qui tam suits and two other matters. In
the first action, a physician and former SIUH
Director of Chemical Dependency Services, filed suit
alleging that SIUH fraudulently billed Medicare and
Medicaid for substance abuse and alcohol
detoxification services provided to inpatients in
unlicensed beds, in violation of state law, between
1994 and 2000. SIUH paid the United States $11.8
million in settlement of this qui tam action, with
the relator receiving $2.3 million as his share of
the government’s recovery. In related allegations of
inflated Medicaid billings asserted under New York
State’s false claims statute, SIUH paid New York
$14.88 million, with the relator receiving $2.97
million as his share of the state’s recovery.
In the second action, the widow
of an SIUH cancer patient filed suit alleging that
between 1996 and 2004, SIUH submitted false claims
to Medicare and TRICARE using incorrect codes for
cancer treatments not covered by the programs. SIUH
paid the United States $25 million, including a
relator share award of $3.75 million. In the third
matter, the United States alleged that SIUH
deliberately inflated the number of residents it
employed to fraudulently increase Medicare
reimbursement between 1996 and 2003. SIUH paid the
United States $35.7 million in settlement of this
matter. Lastly, SIUH paid the United States $1.47
million to settle allegations that it billed
Medicare and Medicaid for treating psychiatric
patients in unlicensed beds from 2003-2005. In
conjunction with the settlement, SIUH also entered
into a Corporate Integrity Agreement with the
Inspector General of HHS to ensure future
compliance.
For the original press release,
see:
http://www.usdoj.gov/usao/nye/pr/2008/2008sep15.html
$60 million from Lester E. Cox
Medical Centers, a health care system headquartered
in Springfield, Mo., to settle claims that it
violated the False Claims Act, the Anti-Kickback
Statute and the Stark Statute between 1996 and 2005.
The United States alleged that Cox entered into
illegal financial relationships with referring
physicians at a local physician group and engaged in
improper billing practices with respect to Medicare.
Under the Stark Statute, providers such as Cox are
prohibited from billing Medicare for referrals from
doctors with whom the providers have a financial
relationship, unless that relationship falls within
certain exceptions. The United States contended that
Cox and the referring physicians ran afoul of the
Stark Statute, as well as the Anti-Kickback Statute,
which prohibits offering inducements to providers in
return for patient referrals. The settlement also
resolves claims that Cox included non-reimbursable
costs on its Medicare cost reports and improperly
billed for dialysis services. In conjunction with
the settlement, Cox entered into a Corporate
Integrity Agreement with the Inspector General of
HHS to ensure future compliance.
For the original press release,
see:
http://www.usdoj.gov/opa/pr/2008/July/08-civ-638.html
http://www.usdoj.gov/usao/mow/news2008/cox.settlement.htm
$53 million from Pratt & Whitney,
a division of United Technologies Corporation, and
PCC Airfoils LLC, a subsidiary of Precision
Castparts Corporation, to resolve allegations that
the companies knowingly submitted false claims for
defective turbine blades purchased by the Air Force
to retrofit the F100-PW-220 engines found in F-16
and F-15 aircraft. The settlement includes
corrective action to replace defective blades and
inspection of potentially serviceable blades to
ensure their integrity. The case was pursued as part
of a National Procurement Fraud Initiative launched
in October 2006, to promote the early detection,
identification, prevention and prosecution of
procurement fraud.
For the original press release,
see:
http://www.usdoj.gov/opa/pr/2008/August/08-civ-675.html
$26 million from St. Joseph’s
Hospital of Atlanta to resolve allegations that the
hospital falsely claimed Medicare reimbursement for
inpatient admissions that were, in fact, less costly
outpatient visits. A registered nurse, formerly
employed by the hospital, initiated suit under the
False Claims Act’s qui tam provisions. The complaint
alleged that the hospital improperly billed for
short inpatient admissions, usually of one day or
less, when the service should have been billed as an
outpatient "observation" or emergency room visit.
Medicare reimburses hospitals a higher rate for
inpatient admissions than it does for observation
care or emergency room visits. The nurse who
triggered the investigation received $4.94 million
as her share of the recovery. St. Joseph’s entered
into a Corporate Integrity Agreement with the
Inspector General of HHS in conjunction with the
settlement, to ensure future compliance.
For the original press release,
see:
http://www.usdoj.gov/usao/gan/press/2007/12-21-07.pdf
$23.2 million from Bechtel
Infrastructure Corp. and PB Americas Inc. to settle
allegations of false claims for federal highway
funds in connection with the firms’ failure to
provide adequate management and quality assurance
services during the construction of the Central
Artery Tunnel, known as the Big Dig, in Boston. The
recovery, part of a $458 million settlement of state
and federal claims, resolved parts of a qui tam
lawsuit, a related federal investigation and
additional claims that Bechtel and PB Americas
violated federal and state criminal and civil laws
in connection with their services on the Big Dig. In
addition to the federal recovery, the companies paid
$40 million in state claims and $335 million into a
state warranty fund for future repairs to the Big
Dig. The private citizen who filed the suit received
$54,000 and $96,000 as his share of the federal and
state recoveries, respectively.
For the original press release,
see:
http://www.usdoj.gov/opa/pr/2008/January/08_crt_048.html
http://boston.fbi.gov/dojpressrel/pressrel08/govtclaimsettlement012308.htm
$21.1 million from CVS Caremark
Corp. to settle claims that from 2000-2006, the
company illegally switched patients from the tablet
version of the drug Ranitidine (generic Zantac) to a
more expensive capsule version for the sole purpose
of increasing Medicaid reimbursement. For example,
CVS pharmacies in Illinois would charge Medicaid
$79.80 for 60 Ranitidine capsules, rather than
$17.10 for the tablets prescribed, increasing
reimbursement by $62.70 on a single prescription.
CVS Caremark is headquartered in Rhode Island and
operates more than 6,000 pharmacies nationwide. The
settlement resolves qui tam claims under federal and
state false claims statutes. In addition to the
federal recovery, CVS Caremark paid $15.6 million to
23 states and the District of Columbia. The qui tam
plaintiff received $4.3 million as his share of the
federal and state settlements. CVS Caremark also
entered into a Corporate Integrity Agreement with
the Inspector General of HHS to ensure future
compliance.
For the original press release,
see:
http://www.usdoj.gov/opa/pr/2008/March/08_crt_214.html
Medicare Fraud, Tricare
Fraud, Nursing Home Fraud, Hospice Fraud, and other
Health Care Fraud in the News (Whistle Blowers
and Government Agents Strike Back Against Health
Care Fraud)
Health care fraud Whistle
blowers, federal agents, and other American heroes
have been striking back against Medicare Fraud,
Tricare Fraud, Nursing Home Fraud, Hospice Fraud,
and other Health Care Fraud. Below are some recent
stories in the news regarding health care fraud and
qui tam claims.
Dozens Arrested In Medicare
Fraud Busts Across US digg Share this on Facebook
Huffpost - Dozens Arrested In Medicare Fraud Busts
Across US
KELLI KENNEDY | 07/29/09 10:31 PM
| AP
"MIAMI — Federal authorities
arrested more than 30 suspects, including doctors,
and were seeking others in a major Medicare fraud
bust Wednesday in New York, Louisiana, Boston and
Houston, targeting scams such as "arthritis kits" –
expensive braces that many patients never used.
More than 200 agents worked on
the $16 million bust that included 12 search
warrants at health care businesses and homes across
the Houston area, where the bulk of the arrests were
made.
Federal authorities say those
businesses were giving patients "arthritis kits,"
which were nothing more than expensive orthotics
that included knee and shoulder braces and heating
pads. Patients told authorities they were
unnecessary and many never even received them. But
health care clinic owners billed between $3,000 to
$4,000 for each kit.
Houston's other scam involved
billing Medicare for thousands of dollars worth of
liquid food like Ensure for patients who can't eat
solid food. Authorities said clinic owners never
distributed the food to patients. In some cases,
clinic owners billed patients who were dead when
they allegedly received the items.
It's the third major sweep since
Attorney General Eric Holder, Health and Human
Services Secretary Kathleen Sebelius announced in
May they were adding millions of dollars and dozens
of agents to combat a problem that costs the U.S.
billions each year.
Using about a dozen agents in
targeted cities, including Miami, the Medicare Fraud
Strike Force, has recovered $371 million in false
Medicare claims and charged 145 people across the
country in just two months."
For more news please go to this
story on Medicare Fraud.
HOSPICE FRAUD NETS MULTIMILLION
DOLLAR RECOVERY
"SouthernCare Inc. and its
shareholders have agreed to pay the United States a
total of $24.7 million to settle allegations that
the Birmingham, Ala.-based company submitted false
claims to the government for patients treated at its
hospice facilities, the Justice Department announced
today. SouthernCare operates approximately 99
locations that provide hospice services in 15
states."
“The Medicare hospice benefit is
intended to provide compassionate end of life care
to terminally ill patients,” said Gregory G. Katsas,
Assistant Attorney General of the Civil Division.
“This settlement sends a clear message that the
Department of Justice will not allow health care
providers to take advantage of beneficiaries in
their attempts to game the reimbursement system.”
This settlement results from two
qui tam suits filed by two former SouthernCare
employees on behalf of the United States. The False
Claims Act authorizes private parties to file suit
against those who defraud the United States and to
receive a share of any recovery. The United States
will pay $4.9 million to the individuals who filed
the actions against SouthernCare.
“Our investigation showed a
pattern and practice to falsely admit patients to
hospice care who did not qualify and to bill
Medicare for that care. This resulted in taxpayers
bearing inappropriate costs. This settlement
evidences the Department of Justice’s efforts to
both protect the public monies and safeguard
Medicare beneficiaries,” said Alice H. Martin, U.S.
Attorney for the Northern District of Alabama.
http://birmingham.fbi.gov/dojpressrel/pressrel09/bh011509.htm
HEALTH CARE FRAUD CASE NETS
RECOVERY OF $1.7 BILLION
HCA Inc. (formerly known as
Columbia/HCA and HCA - The Healthcare Company) and
HCA subsidiaries agreed to pay the United States
over $1.7 Billion including $631 million in 2003 for
civil penalties and damages arising from false
claims the government alleged it submitted to
Medicare and other federal health programs. In 2000,
HCA subsidiaries pled guilty to substantial criminal
conduct and paid more than $840 million in criminal
fines, civil restitution and penalties. HCA will
paid an additional $250 million to resolve
overpayment claims arising from certain of its cost
reporting practices. In total, the government will
have recovered $1.7 billion from HCA.
This Qui Tam settlement resolved
fraud allegations against HCA and HCA hospitals in
nine False Claims Act qui tam or whistleblower
lawsuits pending in federal court in the District of
Columbia. Under the federal False Claims Act,
private individuals may file suit on behalf of the
United States and, if the case is successful, may
recover a share of the proceeds for their efforts.
Under the HCA settlement, the whistleblowers will
receive a combined share of $151,591,500.00.
http://www.usdoj.gov/opa/pr/2003/June/03_civ_386.htm
"Sharp settles suit alleging
fraud at Grossmont Hospital," Cheryl Clark, San
Diego Union-Tribune, 11/23/99.
Hospital Administrators blow the
whistle on Medicare fraud charges alleged that a
hospital improperly increased its revenues from
Medicare by billing the government for services
provided by attending physicians when those services
actually were provided by physicians in training, or
residents. The hospital regularly "upcoded" bills
to Medicare, charging the government for a higher
level of service than was actually provided.
One of the retired health care
administrators that filed the qui tam health care
fraud(whistleblower) lawsuit under the False Claims
Act in federal district court is now a hero for
helping the government crack down on Medicare fraud.
Medicare Fraud Qui Tam Lawyers, Medicaid Fraud Qui Tam
Lawyers, and Health Care
Fraud Lawyers Help Health Care Fraud Whistleblowers Blow the Whistle on Those
that Commit Fraud Against the United States Government
and to Obtain Financial Rewards for Properly Filing a
Qui Tam Whistleblower Case
In 1986 as a result of increased
government contractor fraud, Congress amended the
False Claims Act in order to make it easier for
whistleblowers to file claims against fraudulent
corporations and individuals.
The 1986
Amendment defines a "claim" as:
"...any
request or demand which is made to a contractor,
grantee, or other recipient if the United States
Government provides any portion of the money or
property which is requested or demanded, or if the
government will reimburse such contractor, grantee,
or other recipient for any portion of the money or
property which is requested or demanded."
The whistleblower's share of
recovery is a maximum of 30 percent and the
government's prior knowledge of fraud now does not
necessarily bar a whistleblower from collecting lost
revenue. If the government took over the lawsuit,
the relator can "continue as a party to the action."
The defendant is also required to pay for the
relator's attorney fees. The whistleblower is also
protected from retaliatory actions by his or her
employer. As a result or the amendment, qui tam
lawsuits increased dramatically. Though the
amendment was first made fore corrupt defense
contractors, the amendment has uncovered billions of
dollars in health care fraud.
Anyone who defrauds the
government out of revenue can be held accountable
under the False Claims Act. Common defendants
include defense contractors, health care providers,
other government contractors & subcontractors, state
and local government agencies, and private
universities. Whistleblowers often include current
and former employees of the defrauding company,
competitors of government contractors and public
interest groups.
The False Claims Act was enacted
to encourage private citizens to assist the
government in the fight against fraud. Often the
whistleblower faces an uphill battle as large,
powerful corporations or individuals are usually
named as defendants. An experienced attorney in qui
tam claims may help you gain a percentage of stolen
government funds.
There are several types of Qui Tam
claims covered under the False Claims Act:
Originally, healthcare fraud was
defined as deceptive means used by an organization to
profit from government healthcare agreements. That
definition has more recently been extended to include
not only deception, but also unreasonable ignorance of
the rules.
Healthcare fraud charges stem from
the qui tam provision of the 1986 Federal False Claims
Act, which allows citizens to file a suit on behalf of
the federal government against anyone who has
participated in government fraud. Many believe that one
of the government’s primary motivations for passing this
act was to uncover violations of healthcare contracts;
indeed, healthcare fraud has accounted for more than
half of all qui tam damages recovered since the act was
passed.
If you are a Health Care
Administrator, Hospital Administrator, Nursing Home
Administrator, Doctor, Coder, Benefit Coordinator,
Nurse, Chief Financial Officer, or other health care
professional that has knowledge and evidence of a Health
Care Provider, Hospice Provider, Nursing Home, Hospital,
Medical Supply Company, or other health care contractor
or subcontractor that is defrauding Tricare, Medicare,
or the United States Government out of millions or
billions of dollars, it is important to gather evidence
of the fraud and blow the whistle on the fraud.
In blowing the whistle on health care
fraud, Medicare fraud, Tricare fraud, VA fraud, or other
fraud against the government, it is typically best to
contact a Medicare Fraud, Tricare Fraud, and Hospice
Fraud Qui Tam Claim Lawyer like
Jason S. Coomer and the firms that he works with to
help investigate the fraud and pull together a
disclosure and complaint to file.
For information on this web site or
Qui Tam Whistle Blower Litigation, feel free to contact
Medicare Fraud, Tricare Fraud, and Hospice Fraud Qui Tam
Claim Lawyer,
Jason S. Coomer.