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Health Care Fraud is Estimated to be Over $100 Billion Each Year and Growing as such Health Care Fraud Whistleblowers Are Being Offered Large Rewards to Expose Health Care Fraud by Medicare Fraud Qui Tam Lawyer, Medicaid Fraud Qui Tam Lawyer, and Health Care Fraud Lawyer Jason S. Coomer

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.

Qui tam actions typically revolve around false claims that are either directly or indirectly presented to the Government for "payment or approval." These false claims can be generated through the submission of false bills, records, statements or other representations made to the Government.

There are several types of Qui Tam claims covered under the False Claims Act:

  • Mischarging or overcharging for goods or services.

  • Improper price data and the request for payment for services never provided.

  • Holding government property for fraudulent purposes.

  • Avoiding payment of a debt to the government because of illegal reasons.

  • Knowingly providing the government with defective or dangerous products that were falsely certified.

  • Falsely certifying information for the entitlement of benefits.

  • Having any false claim paid by the government.

The mischarging case is the most common type of qui tam healthcare fraud case that is filed. Mischarging cases generally involve filing false claims for goods or services that were not provided or delivered.  A common mischarging scenario is where a health care provider submits charges for patients that never required these procedures or if the patient did not qualify for certain medical services such as Hospice.  Other common Qui Tam Healthcare Fraud Mischarging Schemes are claims made to the Government for medical services not rendered to a particular patient or for services performed by an attending physician when the service was actually performed by a nurse or other provider that should have been billed at a lower rate.

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.

Health Care Professionals Can Hire a Medicare Fraud Qui Tam Lawyer, Medicaid Fraud Qui Tam Lawyer, or Health Care Fraud Lawyer To Help Blow the Whistle on Those that Commit Fraud Against the United States Government and Collect Financial Rewards Through Qui Tam Whistleblower Laws

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.

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