While it is illegal for medical professionals and healthcare providers in Phoenix, Arizona and across the U.S. to defraud Medicaid or Medicare in order to procure unwarranted federal funds, many still do. For this reason, the federal government incentivizes whistleblowers – often former or current employees – to come forward with information regarding Medicaid and Medicare fraud. Whistleblowers whose inside knowledge about fraud leads to a successful qui tam lawsuit may be eligible to receive between 15 and 30 percent of the total amount of money that the government recovers.
At Tycko & Zavareei LLP, our healthcare fraud attorneys are committed to helping whistleblowers across the U.S. expose fraud and shady business practices that affect American taxpayers each day. If you have proof or inside knowledge of a person or organization committing Medicaid or Medicare fraud, contact the Phoenix Medicare fraud lawyers of Tycko & Zavareei LLP for a free whistleblower consultation.
What is Medicare Fraud?
In 2020 alone, over $25 billion was lost to Medicare fraud, according to the Centers for Medicare & Medicaid Services. Medicare fraud is a comprehensive term that refers to any action taken with the intention of defrauding the Medicare public health insurance program in order to receive or retain undue funds. Common examples of ways in which individuals or organizations commit fraud against Medicare include:
- Misrepresenting a patient’s diagnosis or the services they received
- Unbundling, or billing separately for procedures or services that are normally billed together
- Providing or accepting kickbacks
- Billing for care or services that were not provided, not medically necessary, or not ordered by a doctor
- Falsifying patient files or cost reports
- Providing the patient with, and billing for, unnecessary medical equipment
Understanding the False Claims Act
The False Claims Act (FCA) is a federal law that makes it illegal to submit false claims to the U.S. government for the procurement of undue funds, which includes Medicare fraud. The FCA contains a qui tam provision that allows private citizens with proof of fraudulent activity to file a lawsuit against the company or individual committing the fraud on behalf of the U.S. government. Under this qui tam provision, qui tam relators in Phoenix and elsewhere in the United States are eligible to receive potentially significant financial rewards for their assistance.
How Are Whistleblowers in Phoenix Protected?
Many potential whistleblowers are apprehensive about coming forward and reporting Medicare fraud out of concern that their employer will retaliate against them for exposing the illegal activity. Fortunately, under the FCA and other whistleblower protection laws like the Stark Law and the Anti-Kickback Statute, whistleblowers are protected from all forms of employer retaliation, including:
- Termination, suspension, or demotion as a result of whistleblower actions
- Withholding pay or benefits from an employee who becomes a whistleblower
- Harassing, discriminating against, or subjecting an employee to a hostile work environment because of their whistleblower actions
If a whistleblower does experience retaliation, they may qualify to bring a separate lawsuit against their employer for additional damages, such as reinstatement, back pay, and legal fees. If you brought forth a whistleblower action and experienced employer retaliation as a result, contact the lawyers of Tycko & Zavareei LLP to understand your options for legal recourse.
Why Should I Report Medicare Fraud?
The National Healthcare Anti-Fraud Association estimates that between three and 10 percent of what the government pays out annually in healthcare claims is lost to fraud. Federal programs like Medicare are paid for by the federal government, which means taxpayer dollars indirectly fund them. By reporting fraud and misuse of government funds, whistleblowers can help expose dubious business practices and protect taxpayers’ interests.
In addition, whistleblowers whose qui tam claims lead to the guilty party being ordered to pay the federal government a fine or settlement are entitled to a percentage of the total amount that is recovered. Depending on whether the government agrees to act on the information you provide, you may be entitled to receive between 15 and 30 percent of the government’s total recovery.
Phoenix Medicare Fraud Whistleblower Lawsuits
In 2021, Neurological Associates and Dignity Health D/B/A St. John’s Hospital agreed to pay $10 million to settle claims regarding the violation of the FCA and the improper billing of Medicare. The lawsuit was filed under the qui tam provision by a doctor who worked for the hospital.
In 2018, Banner Health paid $18 million to the U.S. government to settle FCA allegations that 12 of its Arizona and Colorado hospitals billed Medicare for patients who could have been treated on an outpatient basis. This qui tam lawsuit was brought by a former employee who received a monetary reward of over $3 million.
Call a Phoenix Medicare Fraud Attorney Today
At Tycko & Zavareei LLP, our knowledgeable whistleblower attorneys have decades of combined experience in both private qui tam practice and in the U.S. Justice Department. Our qui tam law firm has worked with whistleblowers and the federal government to recover billions of dollars in defrauded funds, including a $350 million settlement agreed to by Advanced Biohealing, Inc., a pharmaceutical device company that was participating in illegal kickback schemes.
Whistleblowers who report Medicare fraud or other forms of fraud against the government may receive a portion of the total funds recovered. If you have proof or inside knowledge of Medicare fraud, contact the Phoenix Medicare fraud lawyers of Tycko & Zavareei LLP today to speak with a qualified healthcare whistleblower attorney.
