Whistleblower, False Claims Act & Qui Tam Information

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by The Law Offices of Jason S. Coomer, PLLC

Dentist Medicaid Fraud Lawsuit, Dentist Office Medicaid Fraud Whistleblower Lawsuit, Dentist Unnecessary Work Medicaid Fraud Lawsuit, Dental Upcoding Medicaid Fraud Lawsuit, Dentist Double Billing Medicaid Fraud Lawsuit, and Dentist Office Qui Tam Whistleblower Lawsuit Information by Texas Dentist Medicaid Fraud Lawyer Jason S. Coomer

Dentist Medicaid Fraud Lawsuits, Dentist Chip Fraud Lawsuits, and  Dentist Medicare Lawsuits are increasing as some dentists are using systematic Medicaid fraud, CHIP fraud, and Medicare to increase their profits including performing unnecessary dental procedures, billing for services not provided, and other false dental billing.  Parents of children with evidence of Dentist Medicaid Fraud, Orthodontist Medicaid Fraud, or Dental Fraud should report the fraud.  If they are the first to file on the Dentist Fraud and have original evidence of the the fraud, the parent or whistleblower may recover a portion of any money that is recovered from the dentist or dental clinic.  In some cases this can be millions of dollars.  Please feel free to contact Dentist Medicaid Whistleblower Fraud Lawyer Jason Coomer via e-mail message or use our submission form for any questions you may have about Dentist Medicaid Fraud lawsuits.

Guardians and Parents Expose Dentist Medicaid Fraud Schemes and Become Eligible for Large Economic Awards
by Texas Dentist Medicaid Fraud Lawyer Jason S. Coomer

Many dentists, dental clinics, and orthodontists have discovered that false billing Medicaid and CHIP for services can generate huge profits.  In these fraudulent dental schemes, the dentist office or dental clinic will often run several promotions offering many free gifts and services to bring in Medicaid patients and CHIP patients.  Once they have the children signed up for Medicaid and CHIP, the dental office will push expensive and unnecessary dental treatments for the children and bill Medicaid for the unnecessary treatment. 

For many of these dental practices, systematic Medicaid fraud creates large profits and because the expenses are paid by Medicaid, many guardians and parents do not realize when fraud or false billing has occurred.  It is important that guardians and parents review the dental services and Medicaid billing to confirm that their children actually did receive the dental services that were billed for and that the dental services were actually necessary procedures for their children.

It is important to realize that systematic Dentist Medicaid fraud can include double billing; upcoding; phantom billing; billing for tests not performed; performing inappropriate or unnecessary procedures; triple billing; charging for equipment, services or supplies never delivered or prescribed; billing for new equipment or supplies, but providing the patient with used equipment; offering free services or supplies in exchange for use of a Medicaid number; unbundling; code jamming; submitting false cost reports to seek higher Medicaid reimbursements than permitted by actual facts; allowing unqualified health care providers to bill for services that they should not provide; falsely seeking payment patients not qualified, and allowing under qualified providers to bill for services that they should not provide. If in reviewing bills for dental services or medical services, there is evidence of systematic Medicaid fraud, it is important to verify the fraud and then properly report the fraud. 

If systematic Dentist Medicaid Fraud is discovered from original and specialized evidence provided from you and you are the first to file on this Medicaid Fraud, you can be eligible to receive a portion of the money that the government recovers from the exposed fraud.  In some cases, this could amount to hundreds of thousands or millions of dollars.

Dentist Medicaid Fraud Lawsuits in the News, Dentist Alleged to Have Committed Medicaid Fraud, and  Unnecessary Dental Work Medicaid Fraud, Dental Upcoding Medicaid Fraud, and Dentist Office Qui Tam Whistleblower Lawsuits

Dentist Medicaid Fraud is on the rise and it is important that Dentist Medicaid Whistleblowers and Dentist Medicare Whistleblowers come forward and blow the whistle on Dentists that are committing Medicaid fraud and Medicare fraud.  These Dentist Medicaid Fraud Whistleblower Lawsuits and Dentist Medicare Fraud Whistleblower Lawsuits can result in large recoveries for not only the government, but also for the brave whistleblower that becomes a successful relator and is able to collect a portion of the recovered money. 

Several Dentists, Dental Management Companies, Dental Clinics, and Dentist Office Professionals, have been the subject of Dentist Medicaid Fraud Whistleblower Lawsuits and Government crackdowns on Dental Medicaid Fraud and Dental Medicare Fraud.  These Dental Medicaid Fraud Whistleblower Lawsuits, Dentist Medicare Fraud Whistleblower Lawsuits, and government crackdowns have uncovered unnecessary dental treatments, dentist Medicaid fraud, Medicaid fraud kickbacks, dental Medicare fraud, and other dental Medicaid fraud that were endangering children and costing taxpayers millions of dollars.

National Dental Management Company Pays $24 Million to Resolve Fraud Allegations Medically Unnecessary Dental Services Allegedly Performed on Children

WASHINGTON - The United States today announced that it has settled False Claims Act allegations against FORBA Holdings LLC, a dental management company that provides business management and administrative services to 69 clinics nationwide known as "Small Smiles Centers." Under the agreement, FORBA will pay the United States and participating states $24 million, plus interest, to resolve allegations that it caused bills to be submitted to state Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid, which is funded jointly by the federal and state governments. FORBA has further agreed to put in place various remedial measures designed to prevent similar unlawful conduct from occurring in the future. The government's investigation of individual dentists is ongoing, and FORBA is cooperating with that investigation by providing information about dentists who may have violated professional standards.

The United States alleged that FORBA was liable for causing the submission of claims for reimbursement for a wide range of dental services provided to low-income children that were either medically unnecessary or performed in a manner that failed to meet professionally-recognized standards of care. These services included performing pulpotomies (baby root canals), placing crowns, administering anesthesia (including nitrous oxide), performing extractions, and providing fillings and/or sealants.

"We have zero tolerance for those who break the law to exploit needy children," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. "Illegal conduct like this endangers a child's well-being, distorts the judgments of health care professionals, and puts corporate profits ahead of patient safety."

Assistant Attorney General West praised the collaborative efforts of the federal and state agencies that made this result possible. The Justice Department's Civil Division and the U.S. Attorneys' Offices for the District of Maryland, the Western District of Virginia, the District of South Carolina, and the District of Colorado handled these cases. The Civil Division led the nationwide investigation, which was conducted by the Office of Inspector General for the Department of Health and Human Services, the Federal Bureau of Investigation, and the National Association of Medicaid Fraud Control Units.

To resolve the allegations against it, FORBA will pay $24 million, plus interest. The federal share of the civil settlement is $14,285,645, and the states' Medicaid share is $9,714,355.25. In addition, as part of the settlement, FORBA has agreed to enter into an expansive five-year Corporate Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services. The agreement provides for procedures and reviews to be put in place to avoid and promptly detect conduct similar to that which gave rise to this matter. Specifically, FORBA must engage external reviewers to monitor its quality of care and reimbursement processes. In addition, the chief dental officer must develop and implement policies and procedures to ensure that the Small Smiles clinics provide services consistent with professionally recognized standards of care. FORBA has also agreed to cooperate in the government's continuing investigation of individual dentists.

"We will not tolerate Medicaid providers who prey on vulnerable children and seek unjust enrichment at taxpayers' expense," said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. "This settlement reaffirms our commitment to protect the health and well-being of Medicaid beneficiaries and to ensure the integrity of this essential health care program."

"Health care providers must be held accountable when they mistreat patients and overcharge insurers," said Rod J. Rosenstein, U.S. Attorney for the District of Maryland. "We are committed to using our affirmative civil enforcement authority to protect patients from inadequate care and protect governmental health coverage programs from fraudulent charges."

The government's investigation was initiated by three lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private citizens to sue on behalf of the United States and share in any recovery. These actions are pending in the U.S. District Courts for the District of Maryland, the Western District of Virginia, and the District of South Carolina. As part of today's resolution, the three whistleblowers will receive payments totaling more than $2.4 million from the federal share of the settlement.

"In this case, FORBA put greed and profits before the well-being of children," said Timothy J. Heaphy, U.S. Attorney for the Western District of Virginia. "It endangered the health and safety of innocent children and defrauded the taxpayer of millions of dollars. Today's settlement addresses these egregious acts and sends a clear message that Medicaid fraud will be expeditiously addressed by this Department."

This settlement with FORBA is part of the government's emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Department of Justice has used to recover approximately $2.2 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department's total recoveries in False Claims Act cases since January 2009 have topped $3 billion.


(LAREDO, Texas) - A federal indictment charging a Laredo dentist and his orthodontist wife with 17 counts of health care fraud has been unsealed, United States Attorney Tim Johnson and Texas Attorney General Greg Abbott announced today. Both defendants, who were arrested yesterday without incident, appeared before United States Magistrate Judge Diana Saldana today. During that hearing the issue of bond was raised. The court has taken the matter under advisement and the defendants were ordered to remain in custody pending her decision.

Carlos Armin Morales-Ryan, 33, and his wife, Nelia Patricia Garcia-Morales, 30, are the owners and operators of Orthogenesis International Centre, a Laredo dentistry and orthodontics business. The indictment alleges that from January 2005 to at least July 2008, the defendants fraudulently submitted claims to the Texas Medicaid program for payment for dental and orthodontic services they did not and could not have rendered because they were not in their offices, in the state of Texas or in the continental United States on the dates and times claimed. Physical presence of the provider is a prerequisite under applicable Texas law and Medicaid regulations for a claim to be submitted and paid for services rendered to a Medicaid beneficiary. The defendants are accused of executing the scheme and defrauding the Medicaid program of a total of $768,215.

Texas Medicaid is a health care program funded in part by the federal government through payroll taxes and in part by the State of Texas.

Each count of health care fraud carries a maximum sentence of 10 years imprisonment without parole and a maximum fine of $250,000 upon conviction.

The investigation leading to the charges was jointly conducted by the FBI, Department of Health and Human Services Office of the Inspector General and the Texas Attorney General Medicaid Fraud Control Unit. The case is being prosecuted by Assistant United States Attorneys Don J. Young and Michael Elliot.


LUBBOCK, Texas — James Crow, 65, of Brownwood, Texas, has been indicted by a federal grand jury in Lubbock on numerous felony offenses involving health care fraud, announced U.S. Attorney James T. Jacks of the Northern District of Texas. Crow, who practices general dentistry in Brownwood, is charged with six counts of false statements involving a health care matter and 18 counts of health care fraud. It is expected that Crow will make his initial appearance in federal court in Lubbock later this month.

The indictment alleges that from January 2004 through December 2007, Crow, a dentist enrolled with Medicaid, filed, and caused to be filed, Medicaid claims for payment of services that he did not render and for payment of services that were billed with improper billing codes. The indictment alleges Crow billed Medicaid for numerous resin-based composites restorations (cavity fillings), when in fact, either no such fillings were performed, or he instead performed other dental services reimbursed at lower rates.

An indictment is an accusation by a federal grand jury, and a defendant is entitled to the presumption of innocence unless proven guilty. However, if convicted, each false statement count carries a maximum statutory sentence of five years in prison and a $250,000 fine. Each of the health care fraud counts carries a maximum statutory sentence of 10 years in prison and a $250,000 fine. In addition, the indictment includes a forfeiture allegation which will require Crow, if convicted, to forfeit a money judgment of the gross proceeds, obtained directly or indirectly, as a result of the offense, of at least $1 million,

The case is being investigated by the Texas Medicaid Fraud Control Unit and the FBI. Assistant U.S. Attorneys Amy Burch and Denise Williams of the U.S. Attorney's Office in Lubbock are in charge of the prosecution.

Heartland Dental To Pay $3 Million In Civil Settlement Includes $1.3 Million for DEA Registration Violations

APR 14 -- (Springfield, IL) - An Illinois company that manages dental practices in 12 states and its chief executive officer have agreed to a $3 settlement million to the United Stated and Illinois under terms of two settlement agreements. Heartland Dental, Incorporated, which is headquartered in Effingham, Illinois, and Richard E. Workman, Heartland's CEO, have agreed to pay $1,650,000 to resolve allegations of improper billing to Illinois Medicaid. In a related settlement, Heartland Dental will pay the U. S. $1,350,000 to resolve allegations that newly hired dentists issued prescriptions prior to registration with the DEA as a means to generate revenue for Heartland.

The $1.3 million settlement will resolve allegations that Heartland Dental allowed newly hired dentists to use the DEA resigration number of other Heartland dentists to issue prescriptions. Under the Controlled Substances Act, a DEA registration number allows healthcare providers, including dentists, to distribute and prescribe controlled substances. The allegation that Heartland misused DEA registration numbers resulted in pharmacies unwittingly submitting claims to Medicaid for invalid prescriptions. There were no allegations the prescriptions at issue were not otherwise medically necessary or that any patients were injured as a result of the prescriptions.

“We take seriously the abuse and misuse of DEA registration numbers in the prescribing of controlled substances,” stated Gary G. Olenkiewicz, Special Agent in Charge of DEA's Chicago Field Division.

“The DEA appreciates our law enforcement partnership and commitment with the FBI, Illinois State Police, the Illinois Attorney General's Office, U.S. Dept of Health and Human Services and the United States Attorney's Office that made this a successful investigation.”

Under terms of a five-year consent decree with DEA, Heartland Dental is prohibited from violating the Controlled Substances Act and agrees to permit DEA investigators to conduct administrative inspections as necessary to confirm compliance with the act without requiring the investigators to obtain administrative inspections warrants.

In addition to the DEA violations, under terms of the settlements, while denying the allegations and legal claims, Heartland resolves allegations that from August 1999 through October 2005, it falsely billed Illinois Medicaid for certain procedures: submitting claims for crown buildups, non-covered services, as restorations and claims for surgical extractions which were or should have been simple extractions.

U.S. Attorney for the Central District of Illinois, Rodger A. Heaton stated, “This multi-million dollar settlement is the latest successful result by our outstanding health care fraud team. We remain committed to work together with our partners to recover monies that have been improperly diverted from Medicare and Medicaid, and where appropriate, seek criminal and civil penalties for those who benefit from the unlawful diversion.”

According to FBI Special Agent in Charge Karen E. Spangenberg, health care fraud investigations are among the highest priority investigations within the FBI's White Collar Crime Program. The FBI conducts between 2,000 and 3,000 new health care fraud investigations each year, by using resources in both the private and public arenas, through partnerships with various federal state and local agencies.

Heartland Dental will pay $1.65 million to the U.S. and Illinois related to a “whistle blower” qui tam lawsuit filed in 2003 by Lori Jamison under the federal False Claims Act and Illinois' Whistleblower Reward and Protection Act. These acts permit private citizens to bring lawsuits on behalf of the United States or the State of Illinois and receive a portion of the employee proceeds of any settlement or judgment awarded against a defendant. Ms. Jamison, a former employee of one of Heartland's predecessor entities, will receive $412,500 as her share of the settlement. Heartland has further agreed to pay Jamison an additional $325,000 for dismissal of additional claims, including expenses, attorney's fees and related costs.

The investigation and negotiations with Heartland Dental were conducted by the U.S. Attorney's Office for the Central District of Illinois, the Drug Enforcement Administration, the Office of the Inspector General of the U.S. Department of Health and Human Services, the Illinois State Police Medicaid Fraud Control Unit, the Illinois Attorney General's Office, and the Federal Bureau of Investigation.

North Carolina Dental Services Chain Pays $10 Million to Resolve False Claims Allegations

WASHINGTON – Medicaid Dental Center (MDC), a privately-owned chain of dental clinics in North Carolina previously known as Smile Starters and Carolina Dental Center, has reached a settlement with the United States and North Carolina to resolve False Claims Act allegations, the Justice Department announced today. Under the agreement, MDC agreed to pay $10,050,000 to resolve allegations that it caused false or fraudulent claims for payment to be presented to the North Carolina Medicaid program by billing for medically unnecessary dental services performed on indigent children.

The United States and the state of North Carolina alleged that MDC and its ownership, including Michael A. DeRose , DDS, P.A., and Letitia L. Ballance, DDS, were liable under the False Claims Act for submitting claims for reimbursement for performing pulpotomies that were not medically necessary. Pulpotomies are considered medically necessary in pediatric dental cases when an infection in a tooth spreads into the pulp chamber of the tooth, requiring the pulp's removal. This procedure is often referred to as a “baby root canal.”

MDC and its ownership also were alleged to have submitted claims for reimbursement for placing stainless steel crowns that were not medically necessary and for failing to obtain informed consent for all medical procedures and services. The settlement is limited to claims submitted to the North Carolina Medicaid program and does not involve any other states.

“These dentists subjected their child patients to invasive and sometimes painful procedures, often for the sake of obtaining money from the North Carolina Medicaid program,” said Jeffrey S. Bucholtz, the acting Assistant Attorney General for the Department's Civil Division.

Both Dr. DeRose and Dr. Ballance have been disciplined by the North Carolina Board of Dental Examiners. Both entered into consent orders with the Board on December 8, 2005. Under the terms of these consent orders, each of the dentists agreed not to contest allegations that dentists employed and trained by MDC performed excessive treatment on seven of MDC's pediatric patients by performing pulpotomies and placing stainless steel crowns when they were not warranted or supported by x-rays or appropriate diagnostic documentation. As part of today's settlement, the Office of Inspector General for the U.S. Department of Health and Human Services has expressly reserved its exclusion authority against MDC and Drs. DeRose and Ballance.

“Health care professionals who abuse their positions and engage in excessive treatment regimens and excessive billing practices will not be tolerated,” said Gretchen C.F. Shappert, U.S. Attorney for the Western District of North Carolina. “The North Carolina Medicaid Program was not created for self-enrichment. It is a public trust. Individuals who use their professional skills to take advantage of that trust will be investigated and held to account for their actions.”

“This settlement with the Medicaid Dental Center demonstrates the commitment of the Office of Inspector General and our law enforcement partners to protect our Nation's children,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. “The Medicaid program is intended to assist the most vulnerable Americans and to help ensure that they receive necessary health services, not to unjustly enrich others at the expense of indigent persons.”

The investigation and settlement of the case was conducted by the U.S. Attorney's Office for the Western District of North Carolina and the Department's Civil Division, along with the Federal Bureau of Investigation, the U.S. Postal Service's Office of Postal Inspection, the Department of Health and Human Services Office of Inspector General, and the North Carolina Attorney General's Medicaid Fraud Investigations Unit.

Dentist Medicaid Fraud Lawsuit, Dental Medicaid Fraud Lawsuit, Medicaid Fraud Dentist Office Federal False Claims Act Whistleblower Lawsuit, Unnecessary Dental Work Medicaid Fraud Lawsuit, Dental Upcoding Medicaid Fraud Lawsuit, Dentist CHIP Fraud Lawsuit, Dentist Unnecessary Procedure Lawsuit, and Dentist Office Whistleblower Lawsuit Information

Dentists, Dental Clinics, Dentist Groups, and other health care professionals that take Medicaid and Medicare payments including Federal Medicaid Benefits and State Medicaid Benefits are becoming more common.  These Dental and Orthodontic Groups take payments from federal and state funded programs for providing basic dental services to individuals and families.  However, in order to increase profits some of these dental clinics, dental groups, orthodontists, dentists, and orthodontic groups provide false billing statements to the government including double billing, triple billing, billing for services not provided, upcoding, or billing for unnecessary services.  This billing fraud is dental Medicaid Billing Fraud, orthodontic Medicaid Billing Fraud, dental Medicare Billing Fraud, and orthodontic Medicare Billing Fraud.

It is important for families with children needing dental care or orthodontic care to be able to obtain these services as well as elderly people to be able to obtain dental care and orthodontic care, but it is also important that health care fraud including Medicare Fraud and Medicaid Fraud are stopped.  Dental Medicaid Fraud Whistleblowers, Dentist Medicare Fraud Whistleblowers, Orthodontist Medicaid Fraud Whistleblowers, Orthodontic Medicaid Fraud Whistleblowers, and other Medicare Fraud and Medicaid Fraud Whistleblowers are an essential necessary part of identifying and stopping health care fraud.

Dentist Medicaid Fraud Lawsuits, Dental Clinic Medicaid Fraud Lawsuits, Orthodontist Medicaid Billing Fraud Lawsuits, Double Billing Medicaid Fraud and Unnecessary Dental Work Medicaid Fraud Lawsuits, Dental Upcoding Medicaid Fraud Lawsuits, and Dentist Qui Tam Whistleblower Lawsuits

As Medicaid and Medicare spending increases, some health care providers including dentists and orthodontists are making false claims for services including billing for services not provided, upcoding services, double billing, and providing unnecessary services.  As such, it is important for Dentists, Orthodontists,  Dentist Office Managers, Orthodontics Office Managers, Medicaid Billing Clerks, Medicaid Coders, and other Dental Professionals to become Medicaid whistleblowers to seek compensation on the government's behalf from companies and people that have defrauded taxpayers out of government money.  Qui Tam Dental Medicaid Fraud Whistleblower Lawyer Jason Coomer helps Medicaid Fraud whistleblowers and Medicare Fraud Whistleblowers determine if they may have a viable Dental Medicaid Fraud lawsuit, Orthodontics Medicaid Fraud lawsuit, Dentist Medicare Fraud Lawsuit, or Orthodontic Medicaid Fraud lawsuit.

Medicaid Billing Fraud Lawsuits, Medicare Billing Fraud Lawsuits, and the Increase in Medicare and Medicaid Spending

Medicaid is a public health care problem in the United States that provides health care, dental care, and orthodontic care for eligible individuals and families with low incomes and resources. The Medicaid Program is jointly funded by state and federal governments, but is managed by the states.  Medicaid is the largest source of funding for medical and health-related services for people with limited income in the United States and the Medicaid program has been increasing.  The fastest growing aspect of Medicaid is nursing home coverage and this is expected to continue as the Baby Boomer generation begins to reach nursing home age. 

Unlike Medicare, which is solely a federal program, Medicaid is a joint federal-state program. Each state operates its own Medicaid system.  Each state's Medicaid Program must conform to federal guidelines in order for the state to receive matching funds and grants.  For many states Medicaid has become a major budget issue as on average the state's matching costs of the Medicaid program is about 16.8% of state general funds. According to CMS, the Medicaid program provided health care services to more than 46.0 million people in 2001. In 2008, Medicaid provided health coverage and services to approximately 49 million low-income children, pregnant women, elderly persons, and disabled individuals. Federal Medicaid outlays were estimated to be $204 billion in 2008.  Medicaid payments currently assist nearly 60 percent of all nursing home residents and about 37 percent of all childbirths in the United States. The Federal Government pays on average 57 percent of Medicaid expenses.

 Texas Dentist Medicaid Fraud Lawsuits, Texas Dental Medicaid Fraud Lawsuits, Texas Orthodontist Medicaid Billing Fraud Lawsuits, South Texas Medicaid Orthodontic Group Medicaid Billing Fraud, South Texas Medicaid Billing Fraud Whistleblower Lawsuits, Texas Medicaid Fraud Double Billing Lawsuits, Texas Unnecessary Dental Work Medicaid Fraud, South Texas Dental Upcoding Medicaid Fraud Lawsuits, and Dentist Office Qui Tam Whistleblower Lawsuits

The Medicaid program in Texas spend about $10 Billion annually on providing health care benefits to the poor.  The Texas Medicaid program includes dental work including check ups, fillings, and braces.  Of the Medicaid services provided, it is thought that there is an increasing amount of Medicaid Billing Fraud that could be costing tax payers hundreds of millions of dollars each year.

As such, it is vitally important for Texas Medicaid Fraud Whistleblowers to step up and blow the whistle on Medicaid Billing Fraud.  Texas Medicaid Whistleblowers, Texas Orthodontic Medicaid Fraud Whistleblowers, and Texas Dentist Medicaid Billing Fraud Whistleblowers need to step up and blow the whistle to stop this Medicaid Fraud.  By filing  Texas Dentist Medicaid Fraud Lawsuits, Texas Dental Medicaid Fraud Lawsuits, Texas Orthodontist Medicaid Billing Fraud Lawsuits, South Texas Medicaid Orthodontic Group Medicaid Billing Fraud, South Texas Medicaid Billing Fraud Whistleblower Lawsuits, Texas Medicaid Fraud Double Billing Lawsuits, Texas Unnecessary Dental Work Medicaid Fraud, South Texas Dental Upcoding Medicaid Fraud Lawsuits, and Dentist Office Qui Tam Whistleblower Lawsuits, Texas Whistleblowers can save the Texas and the United States hundreds of millions of dollars and may be able to recover tens of millions of dollars themselves if they are successful relators.

The Increase in Government Health Care Spending including Medicare Spending, VA Spending, Tricare Spending, and Medicaid Spending is creating More Health Care Fraud, Medicare Fraud, Medicaid Fraud, and VA Medical Fraud and the need for more Medicaid Billing Fraud Whistleblower Lawsuits, Medicare Billing Fraud Whistleblower Lawsuits, and other Health Care Fraud Whistleblower Lawsuits

The United States government as well as several state governments are stepping up efforts to crackdown on Health Care Fraud, Medicare Fraud, and Medicaid Fraud that are costing taxpayers hundreds of billions of dollars.  These efforts include encouraging Medicaid Fraud Whistleblowers and Medicare Fraud Whistleblowers to come forward as well as setting up task forces that are taking down criminals that are involved in Medicaid Fraud and Medicare Fraud.

Health Care Fraud costs United States Tax Payers approximately $90 billion each year through Medicare, Medicaid, and other government health care programs.  Because the Medicare budget, the Medicaid Budget, the VA Budget, the TRICARE Budget, Medicaid Fraud, and Medicare Fraud are continuing to increase each year, it is vitally important that Medicare Fraud Whistleblowers, Medicare Fraud Upcoding Fraud Whistleblowers, Medicare Medicaid Fraud Hospital Whistleblowers, Hospice Medicare Fraud Whistleblowers, and Medicare Medicaid Fraud Nursing Home Whistleblowers continue to step forward and blow the whistle on health care fraud.

For more information on Medicare Fraud and Medicaid Fraud, please go to the following pages on Health Care Fraud, Medicare Fraud, and Medicaid Fraud Health Care Fraud and Abuse Control Program Report and Medicaid Fraud Interagency Coordination Report shows that tens of millions of dollars of Medicaid over payments are made each year.  These overpayments are often the results of double billing, false billing, upcoding, and other types of Medicaid Fraud that costs Tax Payers significant amounts of money.

Medicare is Different from Medicaid, but both Medicare Billing Fraud Whistleblowers and Medicaid Billing Fraud Whistleblowers are needed to File Medical Billing Fraud Lawsuits

In 2009, the Medicare program covered an estimated 45 million persons and this number is expected to grow as about 7,000 people a day are reaching retirement age.  As millions of people are added to the Medicare budget each year, the cost of the Medicare budget is expected to grow. 

The Medicare program consists of four distinct parts which are funded differently:

  • Part A (Hospital Insurance, or HI) covers inpatient hospital services, skilled nursing care, and home health and hospice care. The HI trust fund is mainly funded by a dedicated payroll tax of 2.9% of earnings, shared equally between employers and workers.

  • Part B (Supplementary Medical Insurance, or SMI) covers physician services, outpatient services, and home health and preventive services. The SMI trust fund is funded through beneficiary premiums (set at 25% of estimated program costs for the aged) and general revenues (the remaining amount, approximately 75%).

  • Part C (Medicare Advantage, or MA) is a private plan option for beneficiaries that covers all Part A and B services, except hospice. Individuals choosing to enroll in Part C must also enroll in Part B. Part C is funded through the HI and SMI trust funds. 

  • Part D covers prescription drug benefits. Funding is included in the SMI trust fund and is financed through beneficiary premiums (about 25%) and general revenues (about 75%).[27]

Spending on Medicare and Medicaid is projected to grow dramatically in coming decades. While the same demographic trends that affect Social Security also affect Medicare, rapidly rising medical prices appear to be a more important cause of projected spending increases.

Economic Incentives for Whistleblowers Lawsuits, Government Fraud Lawsuits, and Qui Tam Lawsuits

When a government imposes a penalty, for the doing or not doing an act, and gives that penalty in part to whistleblowers that will sue for the same, and the other part of the recovery goes to the government, and makes it recoverable by action, such actions are called "qui tam actions", the plaintiff is suing on their own behalf as well for the government and taxpayers.

Qui tam provisions of the False Claims Act are based on the theory that one of the least expensive and most effective means of preventing frauds on taxpayers and the government is to make the perpetrators of government fraud liable to actions by private persons acting under the strong stimulus of personal ill will or the hope of gain.

The strong public policy behind creating an economic gain for whistleblowers is that  the government would be significantly less likely to learn of the allegations of fraud, but for persons in certain positions with specialized knowledge of fraud that has been committed. Congress has made it clear that creating this economic incentive is beneficial not only for the government, taxpayers, and the realtor, but is an efficient method of regulating government to prevent fraud and fraudulent schemes.

The central purpose of the qui tam provisions of the False Claims Act is to set up incentives to supplement government regulation and enforcement by encouraging whistleblowers with specialized knowledge of fraud going on in the government to blow the whistle on the crime.

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 takes 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 a 1986 amendment to the False Claims Act, qui tam lawsuits have increased dramatically.   Though the amendment was first made for corrupt defense contractors, the amendment has uncovered billions of dollars in health care fraud and will probably apply to fraudulently obtained TARP and Bail Out Funds.

Dentist Medicaid Fraud Lawsuits, Dentist Office Medicaid Fraud Whistleblower Lawsuits, Dentist Unnecessary Work Medicaid Fraud Lawsuits, Medicare Upcoding Fraud Lawsuits, Dental Upcoding Medicaid Fraud, Dentist Double Billing Medicaid Fraud Lawsuits, and Dentist Office Qui Tam Whistleblower Lawsuits

Through Federal False Claims Act Whistleblower Lawsuits, Qui Tam Lawsuits, and other Government Fraud Lawsuits, hundreds of billions of dollars have been recovered from fraudulent government contractors that have stolen large amounts of money from the government and taxpayers.  Included in the heroes that have helped recover large amounts of money for taxpayers are Whistleblowers that have recovered billions for themselves and a growing number of dentist Medicaid fraud whistleblowers. 

It is extremely important that Whistleblowers continue to expose fraudulent billing practices and unnecessary treatments that cost billions of dollars.   If you are aware of a large government contractor that is defrauding the United States Government out of millions or billions of dollars, contact Texas Federal False Claims Act Whistleblower Lawyer Jason Coomer.  As a Federal False Claims Act Whistle Blower Lawyer, he works with other powerful qui tam lawyers that handle large Government Fraud cases.  He works with San Antonio Qui Tam Lawyers, Houston Medicare Fraud Whistleblower Lawyers, California Healthcare Fraud Lawyers, Dallas Defense Contractor Fraud Lawyers, and other Medicare Fraud Whistleblower Lawyers as well as with Qui Tam Federal False Claim Act Whistleblower Lawyers throughout the United States and the World to blow the whistle on fraud that hurts the United States and taxpayers. 

If you are aware of Medicare Fraud, Defense Contractor Fraud, Stimulus Fraud, Government Contractor Fraud, or other government fraud and are the original source with special knowledge of fraud and want to be a whistleblower and an American Hero, it is important that you promptly and properly step forward to become a whistleblower. For more information about dental fraud whistleblower lawsuits, please feel free to contact Federal False Claims Act Whistleblower Fraud Lawyer Jason Coomer via e-mail message use our submission form, or click on the following links Health Care Fraud Lawsuit Information, Medicare and Medicaid Fraud Lawsuit Information, Defense Contract Fraud Lawsuit Information, or other Government Fraud Lawsuit Information


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