When employees in Philadelphia blow the whistle at work to report fraud against the United States government, including Medicare and Medicaid fraud, they could potentially receive a significant financial whistleblower reward for their bravery and for helping the government recover defrauded funds. Under the False Claims Act, whistleblowers in Philadelphia and across the US who report fraud are protected from employer retaliation and are offered a percentage of any financial recovery that is made through the lawsuit.
At Tycko & Zavareei LLP, our qui tam law firm has represented healthcare whistleblowers throughout the US in protecting taxpayers and uncovering fraud against government-funded programs like Medicare, Medicaid, Veterans Affairs benefits, and TRICARE. If you have proof of healthcare fraud, contact the Philadelphia Medicare fraud lawyers of Tycko & Zavareei LLP today for a free case evaluation.
What is the False Claims Act?
The False Claims Act incentivizes private citizens to help the government combat fraud by offering protection from retaliation and a potential financial reward if the whistleblower lawsuit is successful. Otherwise known as Lincoln’s Law, the False Claims Act is one of the primary tools the government has to fight against fraud that affects American taxpayers. The False Claims Act contains a qui tam provision that allows individuals, referred to as qui tam relators, to file a qui tam lawsuit on behalf of the government against the person or business committing fraud and share in its recovery.
What is Medicare Fraud?
Medicare fraud, like other forms of healthcare fraud, costs Philadelphia taxpayers billions of dollars each year, with over $25 billion lost to Medicare fraud in 2020 alone. Healthcare fraud occurs when medical providers including doctors, nurses, hospitals, physician groups, clinics, or nursing homes file a false or fraudulent claim for reimbursement to health insurance programs like Medicare and Medicaid.
Widespread Medicare fraud also results in the increased cost of healthcare and the increased risk of harm to patients who are put through unnecessary medical procedures to obtain unwarranted reimbursement funds. Common forms of Medicare fraud include:
- Billing for goods, services, or procedures that were never provided to the patient
- Billing for goods, services, or procedures that were not medically necessary for the patient in order to receive insurance reimbursement
- Upcoding, or billing for more expensive goods, services, or procedures than what were actually provided to the patient
- Unbundling, or billing separately for each part of a procedure like they are separate procedures
- Creating false or misleading diagnoses in order to justify medically unnecessary services or procedures
- Defective or illegal drug pricing
- Improper or illegal marketing of pharmaceuticals, including marketing for off-label usage
- Violations of the Stark Law or Anti-Kickback Statute, including accepting bribes or kickbacks for Medicare patient referrals
How are Philadelphia Medicare Fraud Whistleblowers Rewarded and Protected?
When a whistleblower files a lawsuit under the FCA, they are generally entitled to between 15 and 25 percent of what the government is able to successfully recover through litigation, if it decides to take on the case. If the government does not decide to take on the qui tam lawsuit, and the whistleblower and his or her attorney decide to continue with the case, the whistleblower is entitled to between 25 and 30 percent of the recovery.
In addition to potentially receiving a significant financial reward, whistleblowers are also granted protections when they bravely come forward and report fraud and other illegal activities. Under the FCA and other whistleblower protection laws and statutes, it is illegal for an employer to retaliate against an employee because they reported fraud and became a whistleblower.
Under the FCA, an employee may not be fired, demoted, suspended, threatened, harassed, or discriminated against in any way because of their actions as a whistleblower. Whistleblowers who do experience retaliation from their employer have the right to bring an additional lawsuit against their employer for damages.
What is the Pennsylvania Whistleblower Law?
The Pennsylvania Whistleblower Law allows employees who work in the public sector at the city or state level to act as whistleblowers and report evidence of wrongdoings or waste. Like the FCA, the Pennsylvania Whistleblower Law also protects whistleblowers from employer retaliation.
Pennsylvania False Claims Act Settlements
In the year 2021 alone, the Department of Justice was able to recover $5.6 billion through False Claims Act lawsuits. Notable False Claims Act settlements from Pennsylvania include:
- 2014: West Penn Allegheny Health System agreed to pay $1.5 million to settle claims regarding kickbacks and referrals
- 2016: The University of Pennsylvania Health System and Penn Care at Home agreed to o pay over $75,00 to resolve claims regarding false home healthcare bills submitted to Medicare for reimbursement
- 2020: A chain of Pennsylvania nursing homes was ordered to pay $15.5 million to settle False Claims Act allegations regarding billing for medically unnecessary treatments
Contact Our Philadelphia Medicare Fraud Attorneys
The qui tam attorneys of Tycko & Zavareei LLP are recognized across the nation for their efforts in representing whistleblowers and helping them uncover fraud and other shady business practices. Our whistleblower lawyers have worked on a number of qui tam cases that resulted in significant settlements including:
- A national home healthcare provider agreed to pay over $2 million to settle False Claims Act allegations brought forth by a whistleblower represented by Tycko & Zavareei LLP, who received a 17 percent whistleblower reward
- Advanced Biohealing, Inc. agreed to pay $350 million to settle kickback violations reported by a Tycko & Zavareei LLP whistleblower client
- An online pharmacy agreed to pay $5.7 million to settle False Claims Act violations and the whistleblower, who was represented by Tycko & Zavareei LLP, received a 21 percent reward
If you have proof or inside knowledge of Medicare or other forms of healthcare fraud, contact Tycko & Zavareei LLP today to speak with a Philadelphia Medicare fraud lawyer.
