What Healthcare Fraud Whistleblowers Can Expect
- Qui Tam Lawsuits for False Claims Act Actions -

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    Knowledge of Fraud?

    Come Forward... If you have knowledge of deliberate healthcare fraud and are working in the medical industry you may be eligible for a substantial reward from recovered funds for the government under The False Claims Act (FCA). Learn what to expect if you come forward as a qui tam whistleblower from an award-winning attorney, now..

    • Put federal whistleblower protection laws to work for you
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    What Is A Qui Tam Case?

    If you are an medical employee and have knowledge of misconduct or fraud which caused the government financial loss, you may have a claim under the False Claims Act. Qui Tam whistleblower provisions may entitle those who come forward to expose the unlawful action with up to 30% of the governments recovery and has resulted in hundreds of millions of dollars in whistleblower rewards paid out to those who come forward ($530 million in 2011 alone).

    Very Important: The primary purpose of the False Claims Act is to root out fraud - a pattern of deliberate abuse - not billing errors.

    Complaints are brought to the Federal District Court. If the government decides to join a qui tam lawsuit, they may take over the investigation of the allegations with the help of the filing whistleblower's attorney. When the government chooses to intervene in qui tam lawsuits, their probability of success is much higher with the full resources of the federal government brought to bear in the investigation.

    Common types of qui tam fraud include various unlawful actions which cause financial harm to the government programs such as Medicare and Medicaid. Hospitals or hospices who submit false insurance claims, misrepresenting services, selling off-label drugs, or misrepresenting billing items (upcoding), are just a few of the most common examples.

    Hospice fraud commonly includes practices such as unnecessary billing, paying kickbacks or unlawful referral fees for referring patients, kickbacks for prescribing drugs. In addition, nursing homes are required to comply with federal and state laws - providers who are billing Medicaid but fail to comply may also be liable under the qui tam provision of the False Claims Act.

    It's understandable that employee reports of wrongdoing are likely to result in retaliation from their employer. Whistleblower protections along with up to 30% of recovered funds in financial rewards serve to incentivize your coming forward with what you know.

    Coming forward to file a whistleblower lawsuit allows us to hold violators accountable and stop the unlawful practices. With the help of your qui tam attorney, you really can make a difference!

    healthcare fraud legal actions

    Healthcare Fraud: Exposing Medicare Billing Abuse

    Under the qui tam provision of the False Claims Act when healthcare workers blow the whistle on Hospital fraud, they may be entitled to part of the funds recovered as a reward. Current and former employees with knowledge of unlawful actions play an important role in protecting taxpayers from further loss. Examples of fraud include:

    • (Upcoding) The practice of billing for more expensive procedures or tests than those performed to lift Medicare / Medicaid compensation, or falsely diagnosing more severe, more costly patient ailments.
    • A pattern of billing for services and medical procedures not provided to patients.
    • Accepting Medicare or Medicaid patients into hospitals, hospices and nursing homes who do not meet the eligibility requirements.
    • (Unbundling) A practice of billing for procedures, lab tests or services individually which are related and meant to be billed under a single consolidated billing code under Medicare or Medicaid.
    • Substandard care in nursing homes or hospitals in violation to mandated standards of care.
    • Unlawful kickbacks, reimbursements to healthcare providers or doctors for patient referrals.
    • Selling off-label drugs or overcharging for the costs of services including overnight stays, ambulance charges, etc.
    • False information billing for supplies, materials or drugs not used or even purchased.
    • Knowingly using or providing defective medical products, lab tests, or equipment.

    Almost any pattern of behavior which inflates costs, misleads, or provides a pattern of false information to Medicare or Medicaid to increase compensation for the hospital is unlawful.

    By coming forward to report these illegal actions by your healthcare employer you may entitle yourself to a significant monetary reward.

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    pharmaceutical qui tam fraud

    Pharmaceutical Fraud: Unlawful Drug Schemes

    In addition to misrepresenting billing to justify Medicare paying more in compensation, the False Claims Act covers a number of unlawful actions involving pharmaceuticals.

    Complex practices used to pad billing, fraudulently inflate compensation or kickback and prescription actions healthcare providers use which violate the law include:

    • Pharmacies knowingly charging full prescription costs for partially filled prescriptions.
    • Unnecessary prescribing of medications for patients without need.
    • Providing unlawful kickbacks for medical providers to incentivize the use of certain products and prescription of certain drugs.
    • Charging for unused drugs returned to pharmacies.
    • Marketing or using drugs for off-label uses not approved by the FDA.
    • Overcharging the Government prices higher than allowable by law.
    • Knowingly providing expired or defective drugs to patients.

    If you have knowledge of "off-label" marketing or use that does not comply with FDA requirements the False Claims Act may apply. Healthcare workers who come forward to blow the whistle can help put an end to the wrongful reimbursement weighing taxpayers millions of fraudulent costs.

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    window for qui tam legal actions

    Filing a Lawsuit: Qui Tam Statute of Limitations

    Under Section 3731(b)(1), states qui tam actions are required to be brought within six years of the date of violation. A three year tolling provision was added to the False Claims Act in 1986. The shorthand version is 6 years from accrual, 3 from discovery, and never longer than 10 years.

    The trigger date starting the statute of limitations isn't always immediately apparent.

    While every qui tam whistleblower needs to know whether their claim falls within the statute, your qui tam attorney will be able to help you determine if you are eligible. This typically requires:

    • 6 Years from Accrual
    • 3 Years from Discovery
    • 10 Years Maximum Limit

    The FCA limitations period however has been known to be broken and courts are not in agreement to it's application. These deadlines may not be unbreakable, but can serve as guidelines for the filing of a qui tam whistleblower's suit. Additionally, some states have ratified supplemental legislation with additional provisions for handling of civil actions for false claims known as the Florida False Claims Act. For more information visit Florida laws.

    When in doubt, even if you feel you are outside of the limitation period, share what know with a qualified lawyer to help you determine your options..

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    rewards to incentivize whistleblowers

    Who Qualifies To Blow The Whistle?

    Not everyone is in a position to blow the whistle on hospital fraud. For complex qui tam litigation to be successful, the relator who brings suit must be in a position to have knowledge of the unlawful actions and be in posession of evidence.

    Understandable billing mistakes are not the target of FCA, rooting out deliberate fraud is.

    Exposing claims of medicare scams and fraudulent billing practices is most commonly done by insiders employed within the healthcare industry who has uncovered the behavior of the offenders.

    The following workers are most commonly in a position to uncover such complex billing schemes to defraud the government.

    • Employees working in hospitals, nursing homes or hospice facilities
    • Doctors, nurses, assistants and lab workers
    • Hospital administrators, accountants or medical billing specialists
    • Healthcare supervisors, contractors, consultants and individual medical workers

    Even if your job or position wasn't listed, if you are employed and have knowledge of a type of healthcare fraud, your employment attorney will be able to help you determine if it falls under the False Claims Act.

    Coming forward to blow the whistle on deliberate abuse is your right and responsibility - learn what protections the whistleblower laws afford you and claim available rewards for financial recovery today.

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    How Much of a Whistleblower Reward?

    When you come forward with a successful legal action under the False Claims Act you may be eligible to receive a monetary reward for blowing the whistle and exposing the fraud. Qui tam verdicts and settlements take into account the total amount the government recovers from the action. An example Medicare whistleblower lawsuit can mean many millions of dollars in awards for relators after resolution.

    For each individual false claim the company is liable for up to three times the defrauded amount as well as possible penalties.

    When a pattern billing abuse happens, each individual falsified billing item is considered as a false claim and can be added to the total amount of false claims in the legal action.

    During investigation qui tam lawyers can uncover levels of fraud far in excess of what caused the whistleblower to come forward in the first place.

    Whistleblower lawsuits are very complex and the relationships and experience of your legal counsel when bringing qui tam actions to the Federal Government can make or break your case.

    The investigation required to uncover such complicated billing schemes, while maintaining your privacy and confidentiality requires a specialized challenges only the best employment lawyers will face.

    Confidential & Private

    Coming forward to uncover illegal activity by your employer takes courage. Your lawyers understand the seriousness, and will take reasonable action to protect your confidentiality and keep private the role you are playing. They will serve as your champion, ensuring you are aware of your rights and take advantage of the full protections the law provides for coming forward and blowing the whistle.

    Get help. Share your knowledge of healthcare fraud and get your a free no-obligation evaluation now.

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