The healthcare industry is one of the largest and most profitable industries in the United States. Though healthcare practices and individual professionals are trusted with our health and wellness, some instead choose to take advantage of the system and the government.
Tycko & Zavareei LLP is proud to represent healthcare fraud whistleblowers in Houston. Healthcare fraud whistleblowers play an important role in keeping the American healthcare system running by reporting fraud when they see it. If you have evidence of healthcare fraud, contact our Houston whistleblower attorneys to learn more about becoming a whistleblower.
What is Healthcare Fraud?
Healthcare fraud is when a healthcare provider deliberately deceives a federally-funded health insurance program in order to receive benefits or funds to which they are not legitimately entitled. This type of fraud can happen in multiple ways, including but not limited to:
- Kickback schemes: Gifts and other financial incentives in exchange for Medicare or Medicaid business, such as patient referrals
- False billing: Overbilling, upcoding, and more
- Inflated drug pricing: Falsely reporting a higher drug price in order to incentivize healthcare providers to purchase the drug and in turn receive more money when they bill a government-funded healthcare insurance program
Medicaid/Medicare Fraud
Medicaid and Medicare are both government programs that provide medical care to different parts of the population. To qualify for Medicaid, your household income must be under a certain limit which varies by state. People over 65 can qualify for Medicare, though there is an income limit to receive Medicare benefits as well. The benefits for both of these programs are paid out from the government to healthcare providers.
Medicare/Medicaid fraud happens when a provider intentionally bills the program incorrectly in order to receive benefits or payments to which they are not entitled.
Kickback Schemes
A kickback scheme occurs when a healthcare provider accepts gifts from pharmaceutical companies in exchange for prescribing certain medications to their patients, even if they are more expensive. It is essentially a bribe that benefits both the physician receiving the kickback and the pharmaceutical company selling the medication at the expense of the government. Sometimes the patient directly suffers as well if the medication, device, or procedure is not medically necessary, or the risks outweigh the benefits.
About the False Claims Act
The False Claims Act was originally passed in 1863 during the Civil War in order to address the issue of defense contractor fraud. Today, the False Claims Act covers several other types of fraud, including healthcare.
Not only did the False Claims Act make it a crime to knowingly provide the government with false information or documentation in order to receive a payout, but it also enlisted the help of U.S. citizens to help uncover and prosecute fraud. The False Claims Act established protections and rewards for people who have knowledge of fraud and choose to report that information, usually called whistleblowers.
Many whistleblowers are afraid that they will be retaliated against for speaking up. They may fear that they will face demotion, pay cuts, or other forms of backlash if word gets out that they reported their employer. The False Claims Act made this type of retaliation illegal. In addition to protecting whistleblowers, the False Claims Act lays out financial rewards for bravely speaking up. If someone reports fraud and their disclosure leads to a successful recovery of funds, they could be entitled to 15-30% of the money the government recovers from the case.
The Role of a Houston Healthcare Fraud Whistleblower
Since the government only sees the information healthcare providers report to them and not what is going on inside a Houston healthcare practice, they rely on people who have knowledge of fraud to speak up and help them investigate illegal activity.
Blowing the Whistle on Houston Healthcare Fraud: What to Expect
If you suspect healthcare fraud is happening around you, the first step is to speak with a Houston whistleblower attorney, also known as a qui tam lawyer. You should be prepared to bring any evidence you may have that supports your suspicions to the lawyer. The lawyer will then look over the evidence with you, ask you questions, and determine whether or not there may be a case against your employer or a similar entity that you have inside knowledge of.
If there is sufficient evidence to open a case, the lawyer will then help you file a complaint with the proper authorities. This is known as a protected disclosure, and it will be filed through secure channels. The complaint will be under seal, which means that during the investigation only you, your lawyer, and the authorities will know that you have spoken out.
If it is found that the healthcare provider is committing fraud, they will be prosecuted. Under the False Claims Act, the whistleblower may be entitled to a financial reward of 15-30% of what the government collects from the case.
Why Hire a Houston Healthcare Fraud Whistleblower Attorney?
Not only is it helpful to have the advice of a legal expert, but you are also legally required to have an attorney for False Claims Act cases. Having a whistleblower attorney can also protect your anonymity since they are the ones filing papers and speaking on your behalf.
For Houston whistleblowers, having an experienced attorney can be one of the greatest resources possible. If you are looking for a trusted Houston healthcare fraud whistleblower attorney, Tycko & Zavareei LLP is here to help. Contact us for free and confidential consultation today.
