Under the Federal Civil False Claims Act (31 U.S.C., Section 3729), private citizens can act on behalf of the federal or state government to bring an action against government contractors or any company that acts fraudulently with government funds. Under the False Claims Act, a qui tam lawsuit entitles individuals employed by the entity guilty of fraud to bring a lawsuit for fraud-related damages against the offending company.
Fraud Is Rampant In The Medical Industry
Many nursing homes and medical service providers have turned to illegal practices to boost their bottom line. By some accounts, up to 10% of Medicare charges have some type of fraud. Examples of fraud-related qui tam cases in the nursing home setting include:
- Ghost-billing for patients that do not exist
- Using inferior medicine or medical equipment, yet billing the government for the premium services
- Billing more than once for the same service
- Billing for services not performed
- Offering free items or services in exchange for a Medicare or Medicaid number
- Waiving co-payments routinely
- Someone other than the physician completing the Certificate of Medical Necessity
False Claims Lawsuits Can Be Lucrative To Those Who Report Fraud
The government recognizes that fraud in the medical field leads to increased costs and inefficiency. Further, the government realizes that it has the best chance of discovering medical fraud by providing a financial incentive to those who witness illegal acts.
If you uncover a situation where you believe the government is being defrauded, qui tam whistleblowers have the right to recover between 15 and 30 percent of the total amount recovered from the fraud lawsuit. The damages related to qui tam lawsuits can be substantial, as the party initiating the lawsuit can sue for triple the amount of actual fraud damages plus civil penalties ranging between $5,500 and $11,000 per claim.
For example, if a nursing home charged Medicare $50 per physical therapy sessions for 1,000 sessions that it never provided to residents, the potential damages under a qui tam theory could be $11,150,000 ($50 x 1,000 = $50,000 x 3 = $150,000 + 1,000 x $11,000). In this case, the whistle-blowing employee could be entitled to $3,345,000.
In the year 2003 alone, the amount of U.S. recoveries in qui tam cases totaled $7.8 billion, with whistleblowers recovering a total of $1.3 billion. If you suspect any person, company or entity involved in defrauding the government, you should contact an experienced qui tam lawyer.
Experience with the hierarchy of medical organizations
At Rosenfeld Injury Lawyers, not only do we have experience handling qui tam matters, but we have the unique advantage of understanding the inner workings of nursing homes and other medical facilities, having litigated many cases against these entities. We put this experience to work for you. Lastly, qui tam cases require you to act quickly. In many situations, only the first individual to file a claim will have a right to compensation.
If you are an employee of an organization that has intentionally bilked the government out of money, contact our False Claims Act attorneys today for a confidential and free review of your circumstance and a discussion of your legal rights.
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