Each year, doctors, nurses, hospitals, and other healthcare professionals who defraud public healthcare programs like Medicaid and Medicare by filing false claims cost taxpayers billions of dollars. Because of this, individuals with evidence of healthcare fraud are encouraged to report fraud. To incentivize more people to come forward, the government offers a financial reward if defrauded funds are recovered. Qui tam relators who report Medicare fraud are also protected against retaliation from their employers under the False Claims Act for becoming a whistleblower.
The whistleblower attorneys of Tycko & Zavareei LLP have decades of experience representing qui tam relators across the country and helping them expose fraud that hurts American taxpayers. If you have proof of a healthcare professional or institution committing Medicare fraud in Texas, contact the lawyers of Tycko & Zavarei LLP for a free legal case review.
What is Medicare Fraud?
Medicare fraud is a comprehensive term for any action taken with the intent to obtain unfair and unjustified payouts from Medicare. Because public healthcare programs like Medicare are funded by taxpayer dollars, Medicare fraud remains one of the most harmful types of fraud perpetrated against the US government. The rate of improper payments for Medicare in 2020 was 6.27 percent, resulting in a loss of close to $26 billion.
What is the False Claims Act?
The False Claims Act (FCA) is a federal law designed to combat fraud against the government and its federally-funded programs. Enacted in 1863, the FCA allows private individuals – most often employees or former employees with inside knowledge of fraud – to file a qui tam lawsuit in the name of the federal government against the entity committing fraud. Under the FCA, Texas whistleblowers who report Medicare fraud and other illegal activities are protected from retaliation and entitled to a financial award if the qui tam lawsuit is successful.
Examples of Medicare Fraud in Texas
Medicare fraud can take many forms. Some of the most common examples of Medicare fraud in Texas include:
- Charging for care or services that were not provided
- Charging for care or services that were not medically necessary
- Charging for care or services that were more expensive than what the patient received, otherwise known as upcoding
- Charging separately for procedures or services that are normally billed for together, known as unbundling
- Prescribing unnecessary tests or medications
- Violations of the Stark Law and Anti-Kickback Statute, including accepting kickbacks
- Illegally pricing drugs and not complying with Medicare’s best pricing program
- Marketing pharmaceuticals for off-label usage
- Creating false cost reports
Medicare fraud can be carried out by doctors, nurses, hospitals, drug companies, home care companies, and more. Other healthcare workers often have inside knowledge of Medicare scams and can potentially earn significant financial rewards for reporting them. If you have evidence of Medicare fraud, contact the Texas lawyers of Tycko & Zavareei LLP today to learn about your rights as a whistleblower.
How are Texas Medicare Fraud Whistleblowers Protected?
The FCA protects Medicare fraud whistleblowers and other qui tam relators from employer retaliation. Under the FCA, employers are prohibited from firing, suspending, demoting, threatening, harassing, or otherwise discriminating against an employee who reports fraud or becomes a whistleblower. A whistleblower who does experience retaliation may be entitled to different remedies, including reinstatement, back pay, attorneys’ fees, and more.
How are Texas Healthcare Fraud Whistleblowers Rewarded?
The qui tam provision of the FCA allows whistleblowers to receive significant financial compensation for their bravery in coming forward and reporting fraud. If the qui tam claim filed causes the government to recover defrauded funds, the whistleblower could be entitled to between 15 and 25 percent of the financial recovery. If the government does not take action on the case and the whistleblower and their lawyer independently resolve the case, the whistleblower could be entitled to between 25 and 30 percent of the financial settlement.
Past Medicare Fraud Whistleblower Lawsuits in Texas
In 2021, the Department of Justice recovered over $5 billion in healthcare fraud settlements from FCA lawsuits. Some notable settlements from the past include:
- In 2018, John Peter Smith Hospital agreed to pay $3.3 million to settle FCA allegations related to upcoding. In this case, the whistleblower was rewarded over $900,000.
- In 2021, a chiropractor and owner of two clinics in Houston agreed to a settlement of $2.6 million to resolve claims regarding fraudulently billing Medicare for unperformed services.
- In 2021, Flower Mound Hospital Partners LLC paid $18.2 million to settle claims regarding Stark Law and Anti-Kickback Statute violations. The whistleblower, a physician-owner at Flower Mound Hospital, was awarded $3 million.
How Can a Medicare Fraud Whistleblower Help Me?
Coming forward and reporting fraud can be nerve-wracking. Consulting with a qualified qui tam law firm like Tycko & Zavareei LLP can ensure that your claim is viable, your lawsuit is filed properly, and you are protected against retaliation from your employer. Additionally, an experienced qui tam lawyer will work to convince the government to take on your case and fight for the maximum award for your efforts as a whistleblower.
Tell Our Attorneys what You Know about Medicare Fraud in Texas
At Tycko & Zavareei LLP, our qui tam lawyers are committed to protecting taxpayers, fighting government fraud, and advocating on behalf of the whistleblowers who expose it. Our healthcare fraud lawyers have represented whistleblowers across the US and have won multiple favorable settlements resulting in significant financial rewards for qui tam relators. If you have evidence of Medicare fraud in Texas, contact the whistleblower lawyers of Tycko & Zavareei LLP today for a free legal consultation.
