Medicare and Medicaid are funded by taxpayer dollars that are allocated to provide for vulnerable individuals like the elderly, disabled, or poor. Unfortunately, some unethical healthcare providers take advantage of this system and defraud government healthcare programs like Medicare and Medicaid. In doing so, they abuse taxpayer dollars and ultimately hurt patients. Under the False Claims Act, the U.S. incentivizes individuals who report evidence of healthcare fraud against government-funded programs—like Medicare, Medicaid, the V.A., and TRICARE—by offering a portion of any financial recovery made in the form of a whistleblower reward.
The Los Angeles qui tam lawyers of Tycko & Zavareei LLP have helped whistleblowers across the U.S. expose illegal healthcare and business practices and have recovered more than $7 billion in defrauded funds to date. If you have evidence of Medicare, Medicaid, V.A., or TRICARE fraud in LA, contact our Los Angeles healthcare fraud lawyers today for a free and confidential legal consultation.
What is Healthcare Fraud?
Healthcare fraud is a crime that involves providing a federally-funded healthcare program with false or misleading information in an attempt to obtain unauthorized funds. Healthcare fraud can be committed by doctors, nurses, hospital groups, clinics, labs, pharmacies, drug companies, nursing homes, and by other healthcare providers.
Common types of healthcare fraud seen in LA whistleblower lawsuits include:
- Ordering medically unnecessary services
- Falsely claiming and billing for services that the patient never received
- “Upcoding” or billing for more expensive treatments and procedures than what the patient received. Upcoding may also include falsely claiming a patient has a more serious diagnosis than what is true
- “Unbundling” services or procedures that are usually billed together by billing separately for each in an attempt to secure more money
- Accepting or giving kickbacks in the form of financial payments or gifts for patient referrals and other Medicare or Medicaid-funded business
- Accepting or giving kickbacks for prescribing certain drugs
- Creating false cost reports
- Promoting pharmaceuticals for off-label usage
Will I Receive a Financial Reward for Reporting Los Angeles Healthcare Fraud?
Under the federal False Claims Act (FCA), private individuals can bring a lawsuit on the government’s behalf against an individual or business that commits fraud against the government. This is made possible by the FCA’s qui tam provision. As such, whistleblowers are often called qui tam relators.
When whistleblowers’ tips lead to a successful financial recovery of defrauded funds, they are eligible to keep a significant percentage of the total recovered as a reward for their assistance and bravery in reporting healthcare fraud.
If the government acts on the information provided in the qui tam lawsuit, the whistleblower is entitled to between 15 and 25 percent of the total amount recovered. If the government does not intervene and the whistleblower pursues the case independently with their attorney, they can receive between 25 and 30 percent of the amount recovered.
According to the Justice Department, False Claims Act claims led to over $5.6 billion in settlements and judgments in 2021, the second highest recording since the FCA was strengthened in 1986. Working with a Los Angeles qui tam lawyer can help ensure you are adequately compensated for your bravery and cooperation as a whistleblower.
How Are Los Angeles Whistleblowers Protected?
In addition to offering whistleblowers a portion of any financial recovery, the False Claims Act provides whistleblowers with protections from potential retaliation from their employer.
Los Angeles qui tam relators who report fraud, including healthcare fraud, are entitled to protections from employer retaliation. Types of retaliation that are protected under the False Claims Act include being fired, suspended, demoted, discriminated against, or harassed because you report fraud or filed a whistleblower lawsuit. If a whistleblower is retaliated against by their employer, then they can pursue a separate retaliation claim against their employer which can help recover back pay and obtain possible reinstatement.
Notable Los Angeles Healthcare Fraud Cases and Settlements
As one of the largest cities in the United States, Los Angeles is home to numerous hospitals and medical facilities. As such, the city has also been home to multiple large healthcare fraud schemes.
Here are some notable recent settlements and cases involving L.A.-area hospitals and healthcare workers:
- In 2019, a Los Angeles-based doctor and patient recruiter were found guilty of conducting a $33 million healthcare fraud scheme that involved billing Medicare for home health services and medical equipment that patients did not need or never received.
- In 2018, Ontario-based Prime Healthcare Services agreed to pay $65 million to resolve Medicare fraud allegations regarding 14 of its Los Angeles-area hospitals. According to allegations, the hospitals only received patients who required less expensive outpatient services but billed for more expensive treatments and procedures than what they received.
- In 2017, Pacific Alliance Medical Center, a hospital located in Los Angeles, agreed to pay $42 million to settle allegations that it violated the Anti-Kickback Statute and the Stark Law. Violations included improper payments to referring physicians through marketing arrangements and paying above-market rents for office space.
How Can a Los Angeles Healthcare Fraud Lawyer Help Me?
If you are considering becoming a Los Angeles whistleblower, a local qui tam lawyer can assist you by:
- Answering any questions you have and guiding you through the qui tam legal process
- Determining the viability of your qui tam claim
- Filing your claim under the appropriate whistleblower programs
- Protecting you from employer retaliation
- Urging the government to intervene in your qui tam case
- Fighting to make sure you are adequately compensated for your whistleblower contributions
Contact an L.A. Healthcare Fraud Attorney
Los Angeles whistleblowers could be entitled to a significant whistleblower reward if their tips regarding healthcare fraud lead to a successful settlement or judgment. The healthcare fraud lawyers of Tycko & Zavareei LLP are highly experienced in handling a range of different types of qui tam claims and have helped countless whistleblowers shed light on fraud and be rewarded for their efforts. Our whistleblower lawyers’ qui tam cases have led to the recovery of billions in defrauded funds, including a $350 million settlement in a case regarding pharmaceutical kickbacks.
If you are considering filing a qui tam claim, we are ready to help. Contact us today to set up a free consultation with a qualified healthcare fraud lawyer.
