Law enforcement authorities estimate that health-care fraud costs taxpayers between $60 billion and $100 billion each year.  This fraud is expected to continue to increase as over 10,000 people are becoming eligible for Medicare every day.  As the Medicare rolls increase, some for profit health care companies will find ways to illegally and fraudulently make a large profit by double billing, triple billing, charging for services not received, selling products that don't work, providing services that are not necessary, and mass billing patients for goods and services not provided or not needed.

If you are aware of a large health care provider is committing Medicare billing fraud including manipulation of outlier payments to Medicare, kickbacks, upcoding, or bill padding, feel free to contact Medicare Fraud Whistleblower Lawyer Jason Coomer via e-mail message or our submission form about a potential qui tam claim. 

Medicare Fraud Lawsuits (Medicare Qui Tam Fraud Lawsuits)

Health Care Fraud costs United States Tax Payers approximately $80 billion each year through Medicare, Medicaid, 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.

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

Medical Billing and Expense Fraud Law Suits (Qui Tam Claims)

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 defrauding the government. 

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 Claim Article.

Whistleblower Protection Under the Federal False Claims Act

The Federal False Claims Act has strong whistleblower protection provisions that protect Qui Tam False Claims Act whistleblowers from retaliatory actions by violators of the Federal False Claims Act.

Under Section 3730(h) of the False Claims Act, "[a]ny employee who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment by his or her employer because of lawful acts done by the employee on behalf of the employee or others in furtherance of an action under this section, including investigation for, initiation of, testimony for, or assistance in an action filed or to be filed under this section, shall be entitled to all relief necessary to make the employee whole. Such relief shall include reinstatement with the same seniority status such employee would have had but for the discrimination, 2 times the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys' fees. An employee may bring an action in the appropriate district court of the United States for the relief provided in this subsection."

For more information on Whistleblower Protection Under the Federal False Claims Act or other Federal Whistleblower Protections, please go to the following Whistleblower Protection Webpage.

Government Contractor Fraud Qui Tam Whistleblower Lawsuit Information (False Claims Act Whistleblower Qui Tam Action Information)

For more information on Medicare Fraud, Tricare Fraud, Medicaid Fraud, Defense Contractor Fraud, Off Label Fraud, Road Construction Fraud, and other types of False Claims Act Whistleblower Claims, please go to the Qui Tam, Whistleblower, and Federal Federal False Claims Act Information Center.