Qui Tam / Medicare Fraud / Healthcare Fraud / Whistleblower
When it comes to healthcare, Southwest Florida boasts an extensive network of hospitals, walk-in clinics, surgery centers, diagnostic and imaging centers, laboratories, out-patient facilities, medical suppliers, nursing homes, pharmacies, physician networks, and provider groups. Unfortunately, in the healthcare industry, Medicare fraud is all too common, and costs the government tens of billions of dollars each year. Employees who complain, or refuse to participate in the fraud, often suffer wrongful terminations.
For these reasons, the government is willing to pay out large rewards to Medicare fraud whistleblowers, known as “relators”. A “relator” is an individual — often a current or former employee — with inside knowledge of Medicare fraud, who alerts the government to the fraud, and is willing to participate in the government’s prosecution of the fraud under the “qui tam” provisions of the federal False Claims Act.
To be a “relator” in a “qui tam” lawsuit, you have special knowledge about the fraud that the public would not have, and the fraud is based on something you saw or observed first-hand. The more money involved, the better. In fact, substantial money should be at issue, meaning that the fraud is systematic, ongoing, and/or longstanding. You also did not plan or initiate the fraud, although you may have been asked to participate in it. You may have even complained about the fraud, or refused to participate in it, only to have your employer reprimand you or terminate your employment.
You should also have something to support your belief. For instance, our clients typically support their claim with a combination of documents, what they have learned, and what others have told them. (Note: You should not obtain any evidence through illegal means.)
Significantly, to obtain the reward money, the whistleblower or “relator” must be the first to file a lawsuit under the “qui tam” provisions of the federal False Claims Act. For this reason, it is critical, that if you have inside knowledge of Medicare fraud, you do not tell anyone else about it, and call us immediately for a confidential and free consultation with an attorney to discuss your situation, and how we may be able to help you.
Below is a list of common types of Medicare fraud.
- “Phantom Billing” – Billing for tests not performed.
- Performing inappropriate or unnecessary procedures.
- Charging for equipment/supplies never ordered.
- Billing Medicare/Medicaid for new equipment but providing the patient used equipment.
- Billing Medicare/Medicaid for expensive equipment but providing the patient cheap equipment.
- A drug or equipment supplier completing a Certificate of Medical Necessity (CMN) instead of the physician.
- “Reflex testing” – Automatically running a test whenever the results of some other test fall within a certain range, even though the reflex test was not requested by a physician.
- “Defective Testing” – When a test or part of a test was not performed because of technical trouble (ie: insufficient or destroyed sample, machine malfunction) but is billed for anyway.
- “Code Jamming” – Laboratories inserting or “jamming” fake diagnosis codes to get Medicare/Medicaid coverage.
- Offering free services or supplies in exchange for your Medicare or Medicaid number.
- “Unbundling” – Using two or more Current Procedural Terminology (“CPT”) billing codes instead of one inclusive code for a defined panel where rules and regulations require “bundling” of such claims.
- Submitting multiple bills, in order to obtain a higher reimbursement for tests and services that were performed within a specified time period and which should have been submitted as a single bill.
- “Double Billing” charging more than once for the same service, for example by billing using an individual code and again as part of an automated or bundled set of tests.
- “Up Coding” – Inflating bills by using diagnosis billing codes that indicate the patient experienced medical complications and/or needed more expensive treatments. (eg., billing for complex services when only simple services were performed, billing for brand-named drugs when generic drugs were provided, listing treatment as having been for a more complicated diagnosis than was actually the case.)
- “Phantom Employees” – Expensing employees or hours worked that do not exist.
- “Improper Cost Reports” Submitting false cost reports seeking higher Medicare reimbursements than permitted by actual facts.
- Providing substandard nursing home care and seeking Medicare reimbursement.
- Routinely waiving patient co-payments.
If you or someone you know has knowledge of Medicare fraud, please do not hesitate. Call us immediately for a confidential and free consultation with an experienced attorney. There is no charge for the consultation, and no attorneys’ fees unless you make a financial recovery. The stakes are high. Act now.
We pride ourselves on our service to and our focus on Southwest Florida: Naples, Ft. Myers, Sarasota, Bonita Springs, Estero, Marco Island, Immokalee, Port Charlotte, Punta Gorda, Cape Coral, Lehigh Acres, North Port, Bradenton, Collier County, Lee County, Charlotte County, Manatee County, and Sarasota County. We have convenient offices in Naples, Florida, Ft. Myers, Florida, and Sarasota, Florida. We also accept Qui Tam Whistleblower cases in Central Florida: Tampa, St. Petersburg, Clearwater, Lakeland, Orlando, Pinellas County, Hillsborough County, Pasco County, Polk County, Orange County, and Seminole County.
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