Medicaid Fraud Attorney website will help educate the public about various kinds of Medicaid Fraud, as well as the different types of lawyers who specialize in this area of law. For the purpose of this website though, we will mainly focus on Medicaid fraud committed on a large scale by hospitals or clinics. The federal government has also been known to take action against local governments and states for Medicaid fraud. We will go into details about some of those cases later on, but for now, suffice it to say that Medicaid fraud on an institutional level can be reported to the government by individuals with firsthand knowledge of the fraud. This reporting can result in what is known as a Qui Tam Lawsuit, also known as a Whistleblower Lawsuit.
If a supervisor, doctor, or owner of a business that provides Medicaid or Medicare reimbursed services instructs its’ employees to commit fraud related to those services, that business is liable to pay treble damages for the fraud going back as far as 6 years. The person or persons who report the fraud, known as “relators”, are eligible to collect a reward from the government which can be as high as 25% of the amount recovered. Sometimes the reward can be in the millions of dollars. The way an individual can go about collecting this reward is to retain a competent Medicaid Fraud Attorney to file a Whistleblower Lawsuit, also known as a Qui Tam Action.
A Medicaid Fraud Attorney can advise you on how to move forward when reporting suspected fraud in the workplace, and how to protect your job while doing so. For example, let’s say you are a medical biller working in a radiology clinic or hospital and you see things going on that you suspect may be fraudulent. Maybe a supervisor or owner tells you to bill in a way that artificially inflates the reimbursement rate paid to your facility by Medicaid or Medicare. If you question the owner or supervisor, you could get fired, so what do you do? Your attorney will help you come up with a strategy to further your claim without losing your job.
An individual who reports fraud against the government is protected by law from retaliation by their employer. If the individual reporting the fraud is fired, the employer can be forced, through the courts, to rehire the employee and reimburse them for lost wages and legal fees which may have resulted from the retaliation. Needless to say, a court would have to decide if you have been retaliated against, and if so, what the remedy would be.
When you first contact a reputable Medicaid Fraud Attorney, they will interview you in detail about your claim. The attorney will ask you to provide any evidence you may have that substantiates your claim, including documents that can prove fraud has been committed. If the attorney believes that fraud has been committed, they will see if the fraud rises to the threshold the government uses to determine if it will get involved, or intervene in a case. In most cases, this will be a deciding factor as to whether or not a Qui Tam Lawyer takes your case. If the attorney decides to move ahead, they will file a lawsuit on your behalf. This complaint will be filed with several agencies, including the U.S. Attorney’s Office in Washington, D.C. and the Department of Health and Human Services, as well as others. The F.B.I. and agents from HHS OIG are usually brought in to conduct the investigation. If the case prevails in court, a federal judge will rule on how much of your attorney fees will be paid for by the defendant, as well as the amount of reward you are to receive.
Government intervention in a Whistleblower Lawsuit means that the federal government has reviewed the evidence submitted in the lawsuit and determined it will intervene in the case. This basically means that the government has decided your case is worth pursuing and it will take over the investigation and prosecution of your claim. The implications of government intervention in a Qui Tam Lawsuit are huge, mainly because of the consequences the government can impose on the business committing the fraud. These consequences can be civil or criminal, or both. For example, if the government intervenes in a case against a hospital, the government can threaten to take away the Medicaid and Medicare privileges the hospital offers its patients if the hospital decides to fight the suit. This means that if the government prevails at trial, a judge can rule that the hospital is no longer eligible to accept Medicaid or Medicare. The government can also decide if it wants to pursue criminal charges against the people who initiated the fraud. Rather than risk huge financial penalties or possible jail time, the hospital or institution accused of the fraud usually settles the case.
If the government decides not to intervene in your case, the law firm you’ve gone to will have to foot the bill for years of costly litigation without any guarantee of a win if it decides to pursue your claim. It is for this reason that a majority of Qui Tam lawyers will often choose to drop a case if the government does not intervene.
Government intervention in a Whistleblower Lawsuit is decided primarily based on several different factors, including whether the federal government believes there is substantial cause to believe that fraud has been committed, and another is that the alleged fraud has risen to an amount that is worth pursuing. According to most Qui Tam Attorneys, the Federal Government will only intervene in a case if the amount of the fraud is in excess of $6,000,000. The reason for this is because an investigation and prosecution of such a claim can become very costly, and the government wants to make sure they can recover their expenses.
Government intervention in a Whistleblower Lawsuit can often mean including the F.B.I. and other government agencies in the investigation. A relator can be asked to collect documentation of the fraud from the workplace and also may be asked to wear a “wire” to record conversations regarding the fraud. This added information can bolster the government’s case and help secure a large cash reward for the relator.
In 1998, a speech therapist from Watertown, N.Y. came forward with allegations that school districts were putting children, unnecessarily, into Speech and Occupational Therapy, which is paid for by Medicaid. Also attached to the false claims made to Medicaid was the transportation to these unnecessary therapy sessions. The therapist filed a Whistleblower Lawsuit to which the federal government intervened and extended the suit to include other counties throughout New York State. The result was the federal government sued NYS and the counties and recovered more than $500,000,000. Needless to say, the whistleblower in this case was resting fairly comfortably at the outcome. Her reward was reported to be a staggering $10,000,000!
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