Law enforcement authorities have been making great efforts to crack down on estimate that medicare fraud costs taxpayers Billions of dollars each year.  The Health Care Fraud Prevention and Enforcement Action Team, The Joint DOJ-HHS Medicare Fraud Strike Force, and Medicare Fraud Strike Force are just a few law enforcement agencies that have been set up to crack down on Medicare fraud including Hospital Medicare Fraud, Pharmacy Medicare Fraud, and Medical Supply Medicare Fraud.

In addition to law enforcement, whistleblowers are strongly encouraged to blow the whistle on hospital medicare fraud and other forms of medicare fraud.  If you are aware of a hospital committing Medicare billing fraud, feel free to contact Medicare Fraud Whistleblower Lawyer Jason Coomer via e-mail message or our submission form about a potential qui tam claim. 

Hospital Medicare Fraud Whistleblower Lawsuits (Hospital Billing for Unnecessary Procedures Qui Tam Claims, Hospital Upcoding Qui Tam Claims, and Hospital Medicare Outlier Payment Fraud Tam Claims)

Systematic Hospital Medicare Fraud including upcoding, manipulation of outlier payments to Medicare, illegal kickbacks, charging for unnecessary services and procedures, charging for services not provided, double billing, and bill padding, can be difficult to detect and require an inside whisteblower such as a hospital administrator, nurse, therapist, physician's assistant, or doctor to stop the medicare fraud.  Though it can be difficult for the medical professional to blow the whistle on Hospital Medicare Fraud and others in their profession, health care professionals that are complicit and allow others to commit hospital medicare fraud may be subjecting themselves to liability and find that they can be held liable and be at risk for failing to report known hospital medicare fraud.

Hospital administrators can be reluctant to report instances of hospital medicare fraud because of potential retribution that can be taken against them including loss of job and damage to career.  However, provisions of the Federal False Claims Act provide protections to whistleblowers and recent amendments to the Federal False Claims Act have been expanded to protect whistleblowers from retribution.

If you are aware of Hospital Medicare Fraud, it is important to obtain evidence of the  upcoding, manipulation of outlier payments to Medicare, illegal kickbacks, charging for unnecessary services and procedures, charging for services not provided, double billing, bill padding, or other hospital medicare fraud, then contact a hospital medicare fraud lawyer that can assist you with a potential hospital medicare fraud qui tam whistleblower lawsuit.

Law Enforcement and Whistleblower Crackdowns on Medicare Fraud, Charging for Services Not Provided, Charging for Unnecessary Services, Hospital Medicare Fraud, Fraudulent Medicare Billing Practices, and other LawExpense Fraud Law Suits (Hospital Medicare Fraud Whistleblower Qui Tam Claims)

Medicare Fraud costs United States Tax Payers billions of dollars each year through upcoding, manipulation of outlier payments to Medicare, illegal kickbacks, charging for unnecessary services and procedures, charging for services not provided, double billing, bill padding, and other forms of Medicare Fraud.  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.

Stopmedicarefraud.gov is an extension of The Health Care Fraud Prevention and Enforcement Action Team (HEAT). HEAT is currently hard at work tracking down criminals that are stealing from Medicare in several cities across the United States including South Florida, Houston, Detroit and Los Angeles.  "In 2008, the multi-agency enforcement groups known as Medicare Fraud Strike Forces secured 588 criminal convictions; obtained 337 civil administrative actions against individuals and organizations who were committing Medicare fraud, and recovered more than a $1 billion in health care fraud monies under the False Claims Act.  To date, in fiscal year 2009, The Department of Justice has already recovered nearly a billion dollars in health care fraud monies and recorded 300 convictions." 

The 2010 budget for Health and Human Services contains additional funding for anti-fraud efforts over five years. It invests $311 million to strengthen program integrity in Medicare and Medicaid, with particular emphasis on greater oversight of Medicare Advantage and Medicare Prescription Drug programs. The Department of Justice estimates that $2.7 billion could be saved by improving oversight, and stopping fraud and abuse within the Medicare Advantage and Medicare prescription drug programs.

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

Relators that Blow the Whistle on Hospital Medicare Fraud Can Receive Large Amounts of Compensation for Successful Hospital Medicare Fraud Qui Tam Lawsuits (False Claims Act Lawsuits)

The Federal False Claims Act allows citizens to file a suit on behalf of the federal government against anyone who has participated in defrauding the government including any corporation or person that has committed hospital medicare fraud. 

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.  For more information on Qui Tam Claims and Whistleblower Lawsuits, please go to the following Qui Tam, Whistleblower, and Federal False Claims Act Information Center.