Because government programs are largely funded by taxpayers, healthcare fraud involving Medicaid and Medicare costs American taxpayers billions of dollars each year. While most medical professionals abide by the rules, whistleblowers who come forward and report evidence of Medicare fraud under the False Claims Act may qualify to receive a significant financial reward if their healthcare fraud qui tam claim is successful in recovering stolen funds.
The Medicare and Medicaid attorneys of Tycko & Zavareei LLP are dedicated to helping whistleblowers uncover fraud against the government and other illegal business practices. If you have evidence of fraudulent Medicare claims, contact the Des Moines Medicare fraud lawyers of Tycko & Zavareei LLP today for a free qui tam case review.
What is the False Claims Act?
The False Claims Act (FCA) is a federal law that was enacted to combat fraud against the government and its agencies. The qui tam provision of the FCA grants individual citizens the ability to bring forth lawsuits on behalf of the government against individuals or businesses committing fraud.
Under the FCA, whistleblowers, also called qui tam relators, are eligible to receive a portion of any financial recovery or settlement that is reached. To incentivize more potential whistleblowers to report evidence of Medicare fraud, the FCA also grants whistleblowers protections from employer retaliation.
What is Medicare Fraud?
Medicare fraud refers to when healthcare providers, including doctors, nurses, physicians, surgeons, hospitals, and other medical professionals, knowingly submit a false claim to Medicare in order to obtain unwarranted funds or violate the Anti-kickback Statute or Stark law by offering or receiving kickbacks, bribes, or illegal referrals. Examples of Medicare fraud include:
- Upcoding, or billing for a more expensive or complex service than what was provided
- Billing for goods or services that were not provided to the patient or phantom billing
- Unbundling, or billing services separately that are normally grouped together
- Billing for services or procedures that are not medically necessary
- Offering money or gifts in exchange for patient referrals, otherwise known as kickback fraud or violations of the Stark law
- Creating false patient records in order to “prove” the necessity of service, prescription, or procedure
- Creating false expense reports
- Billing for a service performed by someone with a lesser qualification than who was billed for
- Promoting or marketing the use of a pharmaceutical for an off-label purpose
- Pharmaceutical price fixing
- Medical lab fraud
How are Des Moines Medicare Fraud Whistleblowers Rewarded and Protected?
The US government encourages individuals to report fraud by offering a potential financial reward and protection against retaliation. Under the FCA, qui tam relators who report original information regarding fraud against the government, including Medicare fraud, are eligible to receive between 15 and 30 percent of the total financial recovery.
Many potential qui tam relators hesitate to file a whistleblower claim out of fear that their employer will retaliate against them for reporting illegal activity. However, the FCA grants protections from the following forms of employer retaliation:
- Suspension
- Demotion
- Termination
- Harassment
- Discrimination
If the whistleblower still experiences retaliation, they have the right to file a separate lawsuit against their employer relating to the damages incurred as a result of that retaliation. Damages may include reinstatement, double back pay, attorneys’ costs, and legal fees. If you have experienced retaliation after reporting Medicare fraud, contact the Des Moines qui tam attorneys of Tycko & Zavareei LLP today to speak with our team about your options for recourse.
Notable Des Moines Medicare Fraud Cases
Since 1986, the FCA has led to the recovery of over $70 billion in defrauded funds, with $5.6 billion recovered in 2021 alone. Some notable Des Moines FCA lawsuits include:
- 2015: An home care company, ResCare Iowa Inc., agreed to pay a $5.63 million settlement to resolve allegations regarding fraudulent Medicare and Medicaid billing.
- 2018: Iowa Hospital agreed to pay $1.88 million to settle allegations of FCA violations regarding improper inpatient admission.
- 2022: An Iowa-based physician group Tri-State specialists L.L.P. agreed to pay over $600,00 to resolve claims of healthcare billing fraud, including billing for medically unnecessary procedures and billing for services that were not provided.
How Can a Local Medicare Fraud Lawyer Help Me?
Qui tam lawsuits can be complex. If you have original or inside information regarding Medicare fraud and are considering a whistleblower claim, consulting with an experienced lawyer can help ensure your claim is adequately investigated and backed up with evidence and can increase the chances of the government intervening in your qui tam lawsuit and recovering defrauded funds. A qualified Medicare fraud attorney in Des Moines will also fight against employer retaliation to the fullest extent of the law and advocate for the maximum financial reward for your bravery in coming forward and reporting fraudulent Medicare claims.
Contact Our Des Moines Medicare Fraud Attorneys Today
The whistleblower lawyers of Tycko & Zavareei LLP have decades of experience handling FCA lawsuits both in private practice and in the Department of Justice. Our qui tam law firm has worked with whistleblowers across the country to help shed light on fraud and other unethical business practices and has recovered billions of dollars in defrauded Medicare funds. If you have evidence of fraud, contact the Des Moines Medicare fraud whistleblower lawyers of Tycko & Zavareei LLP for a free whistleblower case evaluation.
