Each year, fraud and abuse in the healthcare industry result in the loss of billions of dollars for federal healthcare programs. What is Medicare fraud? Generally, Medicare fraud includes the following:
- Knowingly submitting, or causing to be submitted, false claims, or making misrepresentations of fact to obtain payment from a federal healthcare program;
- Knowingly soliciting, receiving, offering and/or paying remuneration to induce or reward referrals for services reimbursed by Federal health care programs; and
- Making prohibited referrals for certain designated health services.
If you suspect a company is committing Medicare fraud, you may report it anonymously by calling 1-800-MEDICARE or contacting the Office of the Inspector General at 1-800-HHS-TIPS. By reporting Medicare fraud in this manner, you may be eligible for an award up to $1000.
However, you may –and should strongly consider– retaining an attorney to file a whistleblower lawsuit, also known as a qui tam claim, on your behalf. Whistleblower claims filed under the False Claims Act have resulted in substantial recoveries for the Department of Justice – and the whistleblowers. In 2017, the Department of Justice obtained more than $3.7 billion in settlements and judgments from civil cases involving fraud and false claims against the government. Approximately $2.4 billion involved healthcare industry claims. Under the False Claims Act, the whistleblower is entitled to a share of the recovery in the amount of 15-25% of the settlement or judgment.
What about Medicaid fraud? Many states, including Texas, have their own whistleblower laws which govern state-funded healthcare programs like Medicaid and the Children’s Health Insurance Program. If you suspect fraud against the state by healthcare providers, you can report it by calling the Texas fraud hotline at 1-800-436-6184. Similar to federal whistleblower claims, you may also file a qui tam suit under the Texas Medicaid Fraud Prevention Act and avail yourself of a share of the state’s recovery.
The whistleblower lawsuit is filed under seal and remains under seal while the appropriate state and federal agencies investigate your claims. State and federal governments have the option of intervening in the whistleblower lawsuits and prosecuting your claims by using their resources. Should these agencies decline to intervene in your whistleblower case, you have the option of continuing the lawsuit with private counsel. The importance of counsel with whistleblower experience cannot be understated. Sumner Schick attorneys have represented both individuals as plaintiffs and companies as defendants. The firm has successfully defended some of the largest corporations in America in qui tam defense cases, has obtained multi-million dollar settlements for its whistleblower clients, and has a deep understanding of all aspects of qui tam law and procedure.