Medicare billing fraud is costing the United States an estimated one hundred billion dollars ($100,000,000,000.00) each year and with approximately 7,000 new people gaining Medicare benefits each day, it is predicted to continue to increase.  To combat Medicare Billing Fraud and Medicare Payment Fraud, the United States government has amended the Federal False Claims Act to encourage more Medicare Fraud whistleblowers to step up and blow the whistle on Medicare Fraud.  Medicare Billing Fraud Whistleblowers and Medicare Payment Fraud Whistleblowers that are the original source of specialized knowledge of Medicare Fraud can make substantial recoveries if they are the first to file a successful qui tam claim under the Federal False Claims Act.  

For more information on a potential Qui Tam False Claims Act Medicare Billing Fraud Lawsuit or Medicare Payment Fraud Lawsuit, feel free to contact Medicare Billing Fraud Whistleblower Lawyer Jason Coomer via e-mail message or use our submission form to discuss a potential Medicare billing fraud whistleblower lawsuit or Medicare payment fraud lawsuit.

Medicare Payment Fraud Whistleblower Lawsuits, False Coding Lawsuits, Upcoding Lawsuits, and Medicare Billing Fraud Whistleblower Lawsuits

Medicare Billing Fraud Whistleblowers and Medicare Payment Fraud Whistleblowers that provide original source information of schemes to fraudulently bill for medical services or medical products and fraudulently take Medicare payments from our United States government including upcoding, double billing, bill padding, unbundling, and charging for services never provided may recover a portion of the proceeds recovered on the government's behalf.  Since 1986, relators have recovered over $1 billion for helping expose fraud against the United States government.   

To be a Medicare Billing Fraud Whistleblower or a Medicare Payment Fraud Whistleblower, you need to have evidence of original source information of Medicare fraud.  Medical professionals, accountants, benefit coordinators, coding specialists, financial officers, hospital administrators, nurses, medical doctors, and health care administrators often become aware of Medicare Billing Fraud and Medicare Payment Fraud including upcoding, double billing, bill padding, unbundling, and charging for services never provided.

 Medicare Billing Fraud Crackdown Leads to Arrests of Health Care Executives

It is important to blow the whistle on known fraud and not get caught as one of the accomplices.  As the Department of Justice expands Medicare Billing Fraud Crackdowns, it becomes more important for those that are aware of Medicare Billing Fraud and Medicare Payment Fraud Schemes to come forward before the Medicare Fraud Rings are exposed and Health Care Executives start blaming each other and turning on each other to reduce their own potential criminal liability.

Medicare Fraud Strike Force Operations Lead to Charges Against 32 Doctors and Health Care Executives for More Than $16 Million in Alleged False Billing in Houston Early Morning Takedown Leads to Arrests in Houston, New York, Boston and Louisiana

WASHINGTON – Thirty-two people have been indicted for schemes to submit more than $16 million in false Medicare claims in the continuing operation of the Medicare Fraud Strike Force in Houston, Deputy Attorney General David W. Ogden and Deputy Secretary Bill Corr of the Department of Health and Human Services (HHS) announced today. The Strike Force in Houston is the fourth phase of a targeted criminal, civil and administrative effort against individuals and health care companies that fraudulently bill the Medicare program.

While the indictments were returned by a grand jury in Houston, individuals were arrested today in Houston, New York, Boston and Louisiana. In addition, Strike Force agents executed 12 search warrants at health care businesses and homes across the Houston area.

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. The fourth phase was announced in May 2009, with agents from FBI, HHS Office of the Inspector General (HHS-OIG), the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU), the Drug Enforcement Administration (DEA), Office of Personnel Management, Office of the Inspector General (OPM-OIG) and the Office of the Inspector General at the Railroad Retirement Board (RRB-OIG).

"Our Medicare Strike Force is striking back against health care fraud in all its forms and wherever it occurs. We will stop fraud as its happening, using real-time data analysis of Medicare billing records," said Deputy Attorney General David W. Ogden. "Those who commit health care fraud will not be allowed to steal money from American taxpayers. Anyone operating or considering operating a health care fraud scheme around the country should take notice that they will be held accountable."

"When criminals rip off Medicare beneficiaries, we all pay the price. These false Medicare schemes and scams are costing the taxpayers millions of dollars, harming Medicare beneficiaries and driving up the cost of health care, but thanks to this new innovative partnership and the hard work of our staff on the ground, we are starting to fight back against fraud in a big way. The Administration’s HEAT initiative and our Strike Forces are making a big difference in a very short amount of time, returning millions back to the Medicare Trust in just a few months," said Bill Corr, Deputy Secretary of Health and Human Services and the top HHS official on the HEAT Team. "We are also working together across the federal government on important new innovations in the way we do business on the front end, to try and prevent crime like this from happening in the first place."

The Strike Force operations in Houston are another important step of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their joint efforts to reduce and prevent Medicare and Medicaid fraud through enhanced cooperation. The HEAT taskforce, co-chaired by Deputy Attorney Ogden and Deputy Secretary Corr, is made up of top-level law enforcement agents, prosecutors and staff from both Departments and their operating divisions. In the May 2009 announcement, Attorney General Eric Holder and Secretary Kathleen Sebelius announced the expansion of the Strike Force into Detroit and Houston to build upon existing partnerships between the agencies in a heightened effort to reduce fraud and recover taxpayer dollars.

Charges were unsealed today against 32 individuals who are accused of various Medicare fraud offenses, including conspiracy to defraud the Medicare program, and criminal false claims. The Strike Force operations in Houston have identified the primary fraud schemes as those related to false billing for "arthritis kits," power wheelchairs and enteral feeding supplies.

According to the indictments, the defendants charged today participated in schemes to submit claims to Medicare for products that were in fact medically unnecessary and oftentimes, never provided. In some cases, indictments allege that beneficiaries were deceased at the time they allegedly received the items. Collectively, the physicians, company owners and executives charged in the indictments are accused of conspiring to submit more than $16 million in false claims to the Medicare program.

"Americans deserve quality healthcare and have the right to expect that money expended on Medicare is not wasted," said U.S. Attorney Tim Johnson. "We will prosecute anyone who fraudulently obtains Medicare benefits at the expense of the truly needy."

"We will protect the Medicare program and its beneficiaries by stopping those who falsely bill for power wheelchairs, orthotic devices and other supplies that are not needed," said Daniel R. Levinson, Inspector General of the Department of Health & Human Services. "Today’s arrests demonstrate the significant impact of the new HEAT strike force on combating fraud and abuse in the Houston area."

"We will continue to work together to combat those who corrupt the system and wish to line their pockets with taxpayer dollars," said Special Agent in Charge Richard C. Powers, FBI Houston Field Office. "Healthcare fraud strikes at the heart of our health care system and our economy."

Texas Attorney General Greg Abbott added: "Today’s arrests reflect a concerted effort to crack down on those who defraud Texas taxpayers. We will continue working with our federal partners to uncover waste, fraud, and abuse in the Medicare and Medicaid systems."

Since the inception of Strike Force operations in March 2007 with phase one in South Florida, phase two in Los Angeles in May 2008, and phase three in Detroit in March 2009, the Strike Force has obtained indictments of more than 293 individuals and organizations that collectively have billed the Medicare program for more than $674 million. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

Each of the three Houston Strike Force teams is led by a federal prosecutor from the U.S. Attorney’s Office in Houston or the Criminal Division’s Fraud Section. Each team has an agent from the FBI, HHS-OIG and the Texas Attorney General’s MFCU. DEA, OPM-OIG and RRB-OIG also have agents on the teams.

The cases are being prosecuted by attorneys from the U.S. Attorney’s Office, including Assistant U.S. Attorney Jennifer Lowery and Special Assistant U.S. Attorney Justin Blan, on detail from HHS-OIG, as well as from the Criminal Division’s Fraud Section, including Assistant Chief John S. (Jay) Darden and Trial Attorneys Charles Reed, Katherine Houston, Anthony Burba and John Cunningham.

An indictment is merely an allegation, and defendants are presumed innocent until and unless proven guilty.

Remember Medicare Billing Fraud Whistleblowers and Medicare Payment Fraud Whistleblowers not only can avoid potential criminal liability if they expose Medicare Billing Fraud Schemes, but can get an economic incentive for exposing Medicare Billing Fraud, if they are an original source with special knowledge of fraud and are the first to file, they receive a portion of the money that the government recovers.  Depending on the extent of the fraud, qui tam recoveries for the government can be in the billions of dollars and whistleblower recoveries can be in the hundreds of millions of dollars.

There are several keys to a successful False Claims Act Qui Tam Whistleblower action including 1) obtaining original and specialized information of the fraud, 2) being the first to file regarding the specific fraud, and 3) protecting the whistleblower for retaliation. 

Original and Specialized Information of Medicare Billing Fraud or Medicare Payment Fraud is Essential for a Medicare Billing Fraud Whistleblower Lawsuit or a Medicare Payment Fraud Whistleblower Lawsuit

As insiders it is common for a variety of health care professionals, health care executives, and health care administrators to have specialized knowledge of Medicare Billing Fraud or Medicare Payment Fraud.  As such, it is important for these health care administration whistleblowers and health care executive to obtain and preserve evidence of the Medicare fraud.  Whether this evidence is in e-mail messages, memos, accounting documents, coding instructions, recordings, or other documents, it is important for the whistleblower to have evidence of the Medicare fraud.  It is also often helpful to have fellow whistleblowers that can help build the Medicare Billing Fraud or Medicare Payment Fraud case.

Being the First to File on the Medicare Billing Fraud Scheme is Essential for Recovery Under the False Claims Act and can Prevent Potential Criminal Liability

It is also essential to not delay in coming forward with a False Claim Act Qui Tam Action as the first whistleblower to file is eligible to be a relator and make a large recovery for exposing the fraud.  Additionally, when the fraudulent scheme is exposed, the people that kept the fraud secret can sometimes be found liable for criminal activity for not exposing the fraud that was being committed and further be held liable for continuing criminal activity.

Health Care Medicare Billing Fraud Whistleblower Protection, Medicare Payment Fraud Whistleblower Protection, and other Medicare Fraud False Claims Act Whistleblower Protections

It is also important to understand potential whistleblower protections under the False Claims Act and to discuss with an attorney how to prepare for potential retaliation or aggressive attacks by the employer or contractor.  For more information on this topic please go to the following web page on False Claims Act Lawsuit Whistleblower Protections. 

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.

Lilly Pharmaceuticals - $438 million under the False Claims Act In January of 2009, Eli Lilly agreed to pay a total of $1.4 billion to resolve Federal, state and criminal charges in relation to the off-label marketing of the drug Zyprexa. Of this sum, $438 million went to satisfy Federal False Claims Act charges, $361 million was divided among the states, and $515 million was paid as a criminal fine.

Medicare Payment Fraud Whistleblower Lawyers, Texas Medicare Payment Fraud Lawyers, Texas Medicare Billing Fraud Lawyers, and Medicare Billing Fraud Whistleblower Lawyers

If you are aware of a large health care company or individual that is defrauding the United States Government out of millions or billions of dollars, contact Health Care Medicare Fraud lawyer Jason Coomer.  As a Texas Medicare Billing Fraud Lawyer, he works with other powerful qui tam lawyers that handle large Medicare Payment Fraud cases.  He works with San Antonio Medicare Billing Fraud Lawyers, Dallas Medicare Billing Fraud Whistleblower Lawyers, Houston Medicare Payment Fraud Lawyers, and other Texas Medicare Health Care Fraud Lawyers as well as with Health Care Executive Whistleblower Lawyers throughout the nation to blow the whistle on fraud that hurts the United States. 

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. 

For more information on Medicaid Billing Fraud Whistleblower Lawsuits, please go to the following webpage, CHIP Fraud Whistleblower Lawsuit and Medicaid Billing Fraud Whistleblower Lawsuit Information.

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.

Medicare Payment Fraud Whistleblower Lawyers, Texas Medicare Payment Fraud Lawyers, Texas Medicare Billing Fraud Lawyers, and Medicare Billing Fraud Whistleblower Lawyers

If you are a health care executive, health care administrator, medical device marketing representative, medical device marketing executive, medical doctor, or other pharmaceutical or medical device professional with original source knowledge of Medicare Billing Fraud or Hospital Medicare Fraud, it is important that you are the first to step forward to blow the whistle on the Medicare Billing fraud.  If you are a Medicare Billing Fraud Whistleblower that is aware of fraudulent off label drug marketing practices, drug price fixing, drug kickbacks, or other Medicare fraud, feel free to contact Medicare Billing Fraud Whistleblower Lawyer Jason Coomer via e-mail message or our submission form.