Medicare or Medicaid Health Care Billing Fraud

Healthcare billing fraud, through Medicare, Medicaid or other government program, occurs when a healthcare provider bills for unnecessary services or services never received by a Medicare or Medicaid patient.

Medicare or Medicaid fraud is usually committed by hospitals, physicians, pharmacies, medical product or medical device providers, labs, ambulance transportation companies, home healthcare agencies or other medical providers that bill a government program for medical products or services.

Examples of healthcare fraud may include one or more of the following:

• Fraudulent upcoding in medical billing;
• An ambulance company claiming emergency services for a simple transport or entering into a kickback arrangement with hospitals;
• Overcharging for medical goods or healthcare services;
• Kickback or illegal referral arrangements between providers;
• Providing services that are not medically necessary; and
• Claiming and billing for services provided by a physician when the care was provided by a less qualified employee.

If you believe you have witnessed Medicare or Medicaid fraud or health insurance fraud, you may have an actionable False Claims Act claim and may qualify to file a whistleblower lawsuit on behalf of the government. Complete and submit the form at the bottom of this page for a free and confidential case evaluation.

 Government Procurement and Military Contract Fraud

Government contractor fraud usually occurs when companies contracting with a government agency or the military do one or more of the following:

• Overcharge for goods or services.
• Perform sub-standard work or substituting lower quality materials than promised.
• Bill for services not performed.
• Provide inaccurate information about completion, quality, or timeliness of contract work.

Government contractors involved in whistleblower lawsuits include defense (military) contractors, security or environmental contractors, or any other company cheating on their agreements with the Federal or State government.

 If you believe you have witnessed government procurement or military contract fraud, you may have an actionable False Claims Act claim and may qualify to file a whistleblower lawsuit on behalf of the government. Complete and submit the form at the bottom of this page for a free and confidential case evaluation.

Other Fraud Types: SEC Corporate Fraud, IRS Whistleblower Statute & More

If your employer is involved in securities – stock fraud, the Securities Exchange Commission or the “SEC” has a whistleblower statute that rewards people who report corporate fraud and protect them with anti-retaliation rules.

IRS tax fraud — when companies do not pay the IRS taxes they owe or are involved in a scheme to avoid taxes — is covered by the IRS whistleblower rules. If the fraud is substantial the Internal Revenue Service pays tax whistle blower rewards.

If you believe you have witnessed securities or tax fraud, you may have an actionable False Claims Act claim and may qualify to file a whistleblower lawsuit on behalf of the government. Complete and submit the form at the bottom of this page for a free and confidential case evaluation.

The False Claim Act dates back to the Civil War and was signed by President Abraham Lincoln to protect against fraud against the government. It has been amended several times since then to accommodate a variety of situations. 

Qui tam lawsuits are lawsuits filed by whistleblowers under the False Claims Act. A qui tam lawsuit is filed by an individual or another company or business that claims another company or business has defrauded the government in some way.

The person who files a qui tam lawsuit is called the “relator,” commonly known as the whistleblower. A relator may be an employee, former employee, a competitor, or another contractor or subcontractor who has some knowledge of the alleged fraud.

Qui tam lawsuits cannot be based on public information, unless the whistleblower is the source of the public information. The “whistleblower” is considered the original source of the allegations.

Whistleblower lawsuits are the only way to report fraud and collect a cash reward under the U.S. False Claims Act and the 31 State False Claims Acts, including Florida and California False Claims Acts.  The only way to earn a cash reward under the False Claims Act is to file a whistleblower lawsuit.

Qui tam lawsuits are sent directly to the Justice Department for review. They are kept confidential while the government investigates whether or not the allegations are valid. It also gives the government a chance to decide if it wants to join the lawsuit. This is done before the company being charged is informed about the qui tam lawsuit. The government has 60 days to review the lawsuit, but this time is often extended.

The identity of the whistleblower is protected while the complaint is “sealed” and the Department of Justice investigates. In SEC cases the whistleblower’s name is typically never revealed.

The first whistleblower to file the qui tam lawsuit is the one that will be considered by the court, even if another one contains more detail. This is designed to encourage potential whistleblowers not to hesitate to file their whistleblower lawsuits. 

Whistleblowers may receive 15 to 30 percent of the amount of money that the government recovers as a result of the qui tam lawsuit per the U.S. False Claims Act and also the 31 state False Claims Acts that come into play when the government agency that was financially damaged was a state government.

In 2014 and 2015, more than $500 million were paid to whistle blowers each year as rewards ranging in amounts from $75,000 to more than $50 million.

There are anti-retaliation laws protecting whistleblowers who blow the whistle on their own employer or another company. These individuals are provided whistleblower protection under the U.S. False Claims Act, state False Claims Acts, and the IRS and SEC statutes. Whistle blowers are protected against retaliation which includes being fired, demoted or harassed. Penalties for such retaliation include reinstatement and substantial damages. These amounts are in addition to anything received as a cash reward.