Each year, healthcare fraud against government-funded public healthcare programs like Medicare and Medicaid costs Texas taxpayers billions of dollars. Texas healthcare workers who report various forms of healthcare fraud, including healthcare billing fraud, may be eligible to receive a significant financial reward if their whistleblower tip leads to the government reaching a settlement or recovering defrauded funds under the False Claims Act.
If you have evidence, proof, or inside knowledge of ongoing healthcare fraud, a Texas healthcare fraud lawyer can review your qui tam claim, file your claim under the appropriate whistleblower program, and protect your identity throughout the investigation of your claim. Contact the whistleblower attorneys of Tycko & Zavareei LLP today for a free, confidential qui tam case review.
What is the False Claims Act?
In 2021 alone, the US Department of Justice reported that they recovered over $5.6 billion in settlements from lawsuits brought forward under the False Claims Act (FCA). First enacted by President Abraham Lincoln during the American Civil War, the FCA is still one of the government’s main tools for fighting fraud against government-funded programs to this day.
Because of the FCA’s qui tam provision, private individuals have the ability to bring a lawsuit against the entity committing fraud in the name of the US government and are eligible to receive a percentage of any financial recovery made as a result of the claim. These individuals, referred to as whistleblowers or qui tam relators, are also protected from retaliation from their employer for filing a claim under the FCA.
What is Healthcare Fraud?
Healthcare fraud refers to when a medical professional files a fraudulent or misleading reimbursement claim to a healthcare program like Medicaid or Medicare in order to obtain unjustified funds. Common examples of healthcare fraud in Texas include:
- Billing for medically unnecessary goods or services
- Billing for unprovided goods or services
- Billing for more expensive goods or services than what was provided to the patient, also known as upcoding
- Billing separately for goods, procedures, or services that are normally billed together, also called unbundling
- Falsifying or fabricating the patient’s diagnosis in order to justify medically unnecessary procedures, goods, or services
- The illegal or improper marketing of drugs, including off-label usage
- Violating the Anti-Kickback Statute or Stark Law by accepting kickbacks for patient referrals to hospitals, labs, or addiction treatment centers for a financial incentive
- Billing for a procedure done by a doctor when it was actually performed by a nurse or other staff member
- The illegal pricing of pharmaceuticals
If you have knowledge or evidence of healthcare fraud, including any of these illegal business practices, contact the healthcare fraud qui tam lawyers of Tycko & Zavareei LLP today to speak with a professional about your claim.
What is the Texas False Claims Act?
The Texas FCA is modeled after the federal FCA and allows whistleblowers who report fraud against Texas’s Medicaid program to bring forth a lawsuit on behalf of the Texas state government against the individual or organization committing the fraud. Like the Federal FCA, both the Texas FCA and the Texas Medicaid Fraud Prevention Act (TMFPA) – another Texas state whistleblower statute – allow a whistleblower to receive a portion of the government’s recovery.
How are Texas Healthcare Fraud Whistleblowers Rewarded?
Texas healthcare workers who report healthcare billing fraud or other illegal activity in the medical field are eligible to receive a whistleblower reward of between 15 and 30 percent of the total funds recovered by the government under the FCA, the Texas FCA, or the TMFPA. This percentage will vary depending on whether the government agrees to take on the healthcare fraud case. In cases where the government does intervene in the case, the whistleblower can expect to receive between 15 and 25 percent of the recovery. If the whistleblower pursues the case alone with their qui tam lawyer, they can expect to receive between 25 and 30 percent of the recovery.
How are Texas Healthcare Fraud Whistleblowers Protected?
Texas whistleblowers who report healthcare fraud are protected by the federal FCA, the Texas FCA, and the TMFPA from employer retaliation. Forms of employer retaliation that are banned under these whistleblower protection laws include firing, demoting, or suspending an employee for becoming a whistleblower, denying a whistleblower their benefits, or harassing, threatening, or otherwise discriminating against an employee for reporting fraud or other illegal activities.
Texas Healthcare Fraud Settlements
The result of whistleblower lawsuits may vary and include claims regarding healthcare fraud, government contract fraud, tax fraud, securities fraud, and more. Some notable Texas healthcare fraud FCA lawsuits include:
- 2019: Xerox Corporation agreed to pay over $235 million to settle claims brought under TMFPA regarding the processing of prior authorization requests by dentists for Medicaid patients
- 2020: Texas Heart Hospital and THHBP Management agreed to pay $48 million to settle FCA claims regarding allegations of kickbacks and referrals. In this case, the two whistleblowers shared a recovery of close to $14 million
- 2022: 10 Texas doctors agreed to pay over $1.68 million to settle FCA claims regarding kickbacks and referrals
Contact a Texas Healthcare Fraud Attorney
If you have proof of healthcare fraud in Texas, you may be entitled to significant compensation if your qui tam lawsuit is successful. The qui tam attorneys of Tycko & Zavareei LLP have represented whistleblowers in multiple states and helped them shine a light on fraud that affects American taxpayers. Contact the healthcare fraud lawyers of Tycko & Zavareei LLP today for a free qui tam case evaluation to learn how we help Texas whistleblowers.
