What is health care and Medicaid / Medicare fraud?

Health care fraud involves the filing of dishonest heath care claims in order to turn a profit. Examples of practitioner schemes include a health care provider who bills Medicare for services that were not performed or were unnecessary, double-billing, billing for a non-covered service as a covered service, modifying medical records, intentionally reporting incorrect diagnoses in order to maximize payment, and prescribing unnecessary treatment.

How do so-called Whistleblower laws apply to health care fraud?

The False Claims Act holds liable those who knowingly submit, or cause another entity or person to submit false claims for payment of government funds. Those found responsible for fraud are liable for three times the government’s damages plus civil penalties of $5,500 to $11,000 per false claim. Whistleblower provisions included in the False Claims Act allow citizens with evidence of fraud against government contractors and programs to sue, on behalf of the government, to recover the stolen funds. The whistleblower is then eligible to receive a portion of the recovered funds, usually between 15 and 25 percent.

In addition to the federal False Claims Act, many states also have False Claims Acts that work in a similar fashion.

There also is a part of the False Claims Act that is known as the “whistleblower protection” provision. This provision ensures that if you are fired, demoted, suspended, threatened or discriminated against in any other way by an employer as a result of your filing a report of fraud, that you will be reinstated to your former position. This includes receiving any seniority that may have been affected, as well as back pay, interest and other compensation that may be due as a result of damages or losses you suffered as a result of filing a claim.

What can I do?

If you feel you have a claim, our attorneys would like to talk to you. You may be entitled to compensation. Contact us today for a free, no-obligation legal consultation.


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