Healthcare fraud, including laboratory fraud, is a violation of the False Claims Act (FCA), which is a federal law that makes it illegal for individuals or organizations to submit false claims to the government or any of its programs in order to procure undue funds. Employees or lab workers who blow the whistle on healthcare fraud could potentially receive between 15 and 30 percent of any financial recovery reached through a successful qui tam lawsuit.
The Texas lab fraud whistleblower attorneys of Tycko & Zavareei LLP are dedicated to exposing shady business practices and have worked with whistleblowers across the country to recover billions of dollars of defrauded funds. If you have proof of a lab or diagnostic clinic committing fraud against Medicare or Medicaid, contact the attorneys of Tycko & Zavareei LLP today for a free legal consultation.
What Constitutes Lab Fraud in Texas?
Lab fraud refers to the illegal and unethical practice of clinical labs intentionally creating false or misleading lab results, ordering unnecessary tests, or falsifying which tests were actually ordered in order to obtain unwarranted reimbursement funds from Medicaid or Medicare. Common types of lab fraud litigated in whistleblower lawsuits include:
- Billing Medicaid or Medicare for tests that were not medically necessary
- Billing for tests that were not performed or administered
- Billing for tests that were not ordered by a doctor
- Billing separately for tests that are normally billed together, otherwise known as unbundling
- Billing for tests performed at an unlicensed facility
- Billing for tests or labs performed by an unlicensed technician
- Violating the Anti-Kickback Statute by engaging in incentivized referrals
Why Should I Report Texas Lab Fraud?
In 2021 alone, Medicare Part B spent over $9 billion on clinical lab tests, according to the US Department of Health and Human Services. Because federal programs like Medicare are primarily funded through taxes, American taxpayers ultimately pay the price when businesses defraud government funds. Clinical labs that maximize their profit by engaging in fraudulent practices, evading regulation, and ignoring health and safety precautions not only waste taxpayer dollars, but also put their patients’ health and safety at risk.
The government incentivizes potential whistleblowers to come forward with proof of lab fraud and other types of healthcare fraud committed against the government by rewarding qui tam relators with financial compensation if their claim leads to the successful recovery of defrauded funds. Under the qui tam provision of the FCA, whistleblowers are entitled to between 15 and 30 percent of the defrauded funds that the government recovers.
Legal Protections for Fraud Whistleblowers in Texas
The FCA and other whistleblower laws protect employees who file qui tam claims from employer retaliation. Under the FCA, no employee should be fired, demoted, suspended, harassed, or discriminated against because of their actions as a whistleblower. Qui tam relators who do experience retaliation have the right to bring a separate claim against their employer for damages including reinstatement, back pay, and attorneys’ fees.
Texas Lab Fraud Whistleblower Lawsuits
In 2019, a Texas-based pathology lab known as Miraca Life Sciences Inc. agreed to pay $63.5 million to settle violations of the FCA and Anti-Kickback laws. The case stemmed from three whistleblower lawsuits that were filed under the FCA’s qui tam provision.
In April 2022, the founders of three Texas-based medical labs pleaded guilty to a $300 million healthcare fraud scheme. The 11 defendants were implicated in an illegal kickback conspiracy in which the defendants offered kickbacks to incentivize doctors to order medically unnecessary tests that would then be billed to Medicaid.
In a 2019 national lab fraud case, 35 defendants across Georgia, Texas, Florida, and Louisiana were criminally charged with an illegal bribery and kickback scheme that cost federal healthcare programs over $2 billion.
How Do I Report Lab Fraud in Texas?
If you have proof of lab fraud or other healthcare fraud taking place in Texas and are ready to come forward as a whistleblower, the first thing you should do is contact a qualified whistleblower lawyer who can guide you through the legal process and protect your interests. An experienced attorney will be able to determine if the evidence you have of fraud is strong enough for a qui tam lawsuit.
If your claim is valid, your lab fraud attorney will file the lawsuit against the appropriate party. This lawsuit is sealed, and your identity will be kept anonymous throughout the duration of the investigation.
After the investigation is complete, the government will decide whether or not to intervene in the case. If the government does not intervene, you and your lab fraud lawyer may continue the lawsuit. If it is successful, you will be entitled to between 25 and 30 percent of what is recovered.
If the government does intervene, it will litigate the remainder of the lawsuit, but the whistleblower will still be entitled to receive between 15 and 20 percent of the total recovery.
Reach out to a Texas Lab Fraud Whistleblower Attorney
At Tycko & Zavareei LLP, our qui tam law firm is solely dedicated to protecting the rights of whistleblowers and helping expose fraud and other shady business practices that affect American consumers and taxpayers. Our lawyers have represented whistleblowers across the country and aided in the recovery of over $7 billion of defrauded taxpayer money.
If you have proof of Medicare or Medicaid fraud taking place at a clinical laboratory, contact the Texas lab whistleblower lawyers of Tycko & Zavareei LLP today to speak with a qualified attorney regarding your qui tam claim.
