Do you have knowledge and evidence of an ongoing Medicare fraud or Medicaid fraud against the government? Did you know that the government has enacted laws which allow individual citizens to hire an attorney to 'blow the whistle' on such practices, and in many cases receive a large portion of any funds recouped by the government as a result of such whistleblowing lawsuits?
Whistleblowers are people who know and can prove that the federal government or government of the State of Texas is paying or has paid claims or invoices to companies based on false or misleading information. Whistleblowers may inform the government of fraudulent activities occurring in their work place or by another company, but the whistleblower must provide proof of fraud. The federal False Claims Act and the Texas False Claims Act allows these whistleblowers, with their attorney, to file a “qui tam” lawsuit against the wrongdoer. A qui tam lawsuit is a lawsuit brought by a private citizen to recover the government’s money on the government’s behalf. Most of these lawsuits involve Medicare and Medicaid fraud against the government, and the lawsuits are filed by either employees, former employees, or anyone else how knows of and can prove that someone has been filing false claims with the government.
The most common types of fraud are listed below, although other frauds exist:
1) A contractor falsifies test results or other information regarding the quality or cost of products it sells to the Government.
2) A health care provider bills Medicare for services that were not performed or were unnecessary.
3) A grant recipient charges the Government for costs not related to the grant.
4) Billing for goods and services that were never delivered or rendered.
5) Billing for marketing, lobbying or other non-contract related corporate activities.
6) Submitting false service records or samples in order to show better-than-actual performance.
7) Presenting broken or untested equipment as operational and tested.
8) Performing inappropriate or unnecessary medical procedures in order to increase Medicare reimbursement.
9) Billing for work or tests not performed.
10) Billing for premium equipment but actually providing inferior equipment.
11) Automatically running a lab test whenever the results of some other test fall within a certain range, even though the second test was not specifically requested.
12) Defective testing - Certifying that something has passed a test, when in fact it has not.
13) "Lick and stick" prescription rebate fraud and "marketing the spread" prescription fraud, both of which involve lying to the government about the true wholesale price of prescription drugs.
14) Unbundling - Using multiple billing codes instead of one billing code for a drug panel test in order to increase remuneration.
15) Bundling -- Billing more for a panel of tests when a single test was asked for.
16) Double billing - Charging more than once for the same goods or service.
17) Upcoding - Inflating bills by using diagnosis billing codes that suggest a more expensive illness or treatment.
18) Billing for brand -- Billing for brand-named drugs when generic drugs are actually provided.
19) Phantom employees and doctored time slips: Charging for employees that were not actually on the job, or billing for made-up hours in order to maximize reimbursements.
20) Upcoding employee work: Billing at doctor rates for work that was actually conducted by a nurse or resident intern.
21) Yield burning -- skimming off the profits from the sale of municipal bonds.
22) Falsifying natural resource production records -- Pumping, mining or harvesting more natural resources from public lands that is actually reported to the government.
23) Being over-paid by the government for sale of a good or service, and then not reporting that overpayment.
24) Misrepresenting the value of imported goods or their country of origin for tariff purposes.
False certification that a contract falls within certain guidelines (i.e. the contractor is a minority or veteran).
25) Billing in order to increase revenue instead of billing to reflect actual work performed.
26) Failing to report known product defects in order to be able to continue to sell or bill the government for the product.
27) Billing for research that was never conducted; falsifying research data that was paid for by the U.S. government.
28) Winning a contract through kickbacks or bribes.
29) Prescribing a medicine or recommending a type of treatment or diagnosis regimen in order to win kickbacks from hospitals, labs or pharmaceutical companies.
30) Billing for unlicensed or unapproved drugs.
31) Forging physician signatures when such signatures are required for reimbursement from Medicare or Medicaid.
Persons who submit false claims to the government, whether the United States or the State of Texas, are liable for three times the amount of the damages the government sustains plus penalties of $5,000 to $11,000 per instance of fraud. Therefore, for every $5,000 defrauded from the government, the company defrauding can be liable for up to $26,000 in Court. Every year, around the country, thousands of such lawsuits are filed by private citizens with the assistance of law firms such as our firm. Hundreds of millions of dollars are recovered for the State of Texas and the federal government every year, by citizens with knowledge of such fraud who want to help put an end to these practices.
Further, the government pays the people that bring such lawsuits to recover such funds a large sum of money to report the fraud and bring the lawsuit. If you know of ongoing cheating and fraudulent behavior going on against the government, you are able to hire an attorney to try to expose the fraud and by law you will receive between 15% and 30% of any monies recovered by such lawsuit, depending on the circumstances.
The procedures for filing these claims requires the assistance of a knowledgeable attorney in order to get the best possible outcome. The citizen, through his or her attorney, files the lawsuit in Court “under seal”, meaning the lawsuit is not available to the public and cannot be discussed with anyone except the governmental unit and officials investigating the case. The lawsuit remains under seal for 60 days while the defrauded governmental unit investigates. At the conclusion of this time, the government makes a decision whether to join the lawsuit with the private citizen. If the government does join the lawsuit, the lawsuit goes forward with the government attorneys and the citizen’s attorney working together to prove such cases of fraud. If the government does not join the lawsuit, then the citizen through their attorney may go forward without the government.
The first person to file a lawsuit against a company for defrauding the government owns the right to bring the lawsuit, and anyone who does so thereafter is too late, and is prevented from doing so. Therefore it is always best to beat other possible whistleblowers to hiring an attorney and getting the lawsuit filed, so you can recover the funds.
If you know of, and can get evidence to prove, Medicare fraud, Medicaid fraud, or other fraud against the government, being perpetrated by your current employer, or a past employer, or someone with whom you do business, call our knowledgeable law firm now to discuss what rights you may have to recover on behalf of the United States government or the State of Texas today. In the process, you can be entitled to your 15% to 30% share of any monies recovered by blowing the whistle on fraud against the State of Texas or United States government.