Healthcare fraud involving the Medicare and Medicaid programs costs taxpayers over $100 billion annually. If you have information about healthcare fraud, you may be entitled to a significant reward for reporting it. That’s where Levy Goldenberg can assist you.

Our firm has extensive experience litigating qui tam claims under the False Claims Act. When you meet with us, we will determine whether your claim is valid, file and litigate your case, and protect your whistleblower rights. Contact us today to discuss your case in confidence. 

About the False Claims Act

The False Claims Act (FCA) is a crucial tool against fraud involving government contracts and programs in various sectors, including healthcare. The primary purpose of the FCA is to protect the government from being overcharged for goods or services by allowing the government and whistleblowers to bring legal action against individuals or entities that defraud governmental programs. Key provisions of the FCA include:

  • Liability – The Act holds individuals and entities liable for knowingly submitting or causing the submission of false claims for government payment.
  • Triple damages and penalties – Offenders may be required to pay up to three times the government’s loss plus significant penalties.
  • Whistleblower incentives – Whistleblowers, or ‘relators’, can file claims on behalf of the government and may receive a portion of the recovered funds.
  • Protection against retaliation – The FCA protects whistleblowers against retaliation from their employers.

The FCA is essential in combatting healthcare fraud, which involves illegal practices aimed at receiving unentitled payments or benefits from health insurance programs, notably Medicare and Medicaid. The FCA allows whistleblowers and the government to pursue legal actions against entities and individuals who falsely bill these programs, overcharge for services, or submit claims for services not rendered. In short, the False Claims Act serves as a deterrent against fraud and helps to safeguard the integrity and financial sustainability of healthcare programs.

Understanding Qui Tam Claims

The qui tam provisions of the FCA provide a powerful mechanism for combating fraud against the government by allowing relators to file lawsuits on behalf of the government, essentially acting as private attorneys general. The process of filing a qui tam claim is structured to incentivize and protect relators. The key aspects include:

  • Relator’s share of recovery – Relators may receive a percentage (typically between 15% and 30%) of the amount recovered by the government.
  • Filing under seal – Qui tam lawsuits are initially filed confidentially, giving the government time to investigate the claims without public knowledge.
  • Right to proceed if the government declines – If the government decides not to intervene, the relator has the right to proceed with the case on their own.
  • Legal representation – Relators are required to be represented by an attorney

Relators often are insiders, such as healthcare professionals or employees, who have firsthand knowledge of fraudulent practices like billing for non-rendered services, upcoding, or kickbacks. By empowering these individuals to act, the FCA enables the exposure of fraud that would otherwise drain critical resources from government-funded healthcare programs.

Identifying Healthcare Fraud

Healthcare fraud involves various illegal practices aimed at deceitfully extracting funds from government healthcare programs such as Medicare and Medicaid. Common examples of healthcare fraud include:

  • Billing for services not rendered – submitting claims for medical services or treatments that were never provided.
  • Upcoding – charging for more expensive services or procedures than those performed.
  • Unbundling – billing each step of a procedure as if it were a separate procedure.
  • Kickbacks –  receiving illegal payments in exchange for referrals or prescribing certain drugs or treatments.

By incentivizing whistleblowers to come forward, the FCA ensures the integrity and sustainability of vital healthcare programs, ultimately benefiting both the healthcare system and its beneficiaries.

Filing a Qui Tam Claim

The legal process of pursuing a qui tam claim is complex and multifaceted and typically unfolds in the following steps:

  • Filing the complaint – A relator files a complaint confidentially in federal court.
  • Investigation – The government investigates the allegations, during which time the complaint remains under seal.
  • Decision to Intervene – The government decides whether to intervene and take over the case or allow the relator to proceed alone.
  • Litigation – If the case moves forward, it enters the litigation phase, which involves discovery, pre-trial motions, and potentially a trial.

While this seems straightforward, qui tam claims present several challenges. First, the requirement for relators to present substantial evidence can be a significant hurdle, as it often requires detailed inside knowledge of the fraudulent activities. Second, the cases can be lengthy and complex, demanding considerable time and resources. Moreover, the relator must navigate the intricacies of federal law and the specific requirements of the FCA, which makes having informed representation and guidance essential. 

Bringing a qui tam claim can be challenging, requiring significant time and resources to investigate and litigate. As a realtor, you must have evidence of healthcare fraud,  which can be difficult without access to internal company documents. 

When you partner with us, we will advise you about the process, the potential risks and rewards of bringing a qui tam claim, and your rights and obligations under the law. If we find your claim is viable, our qui tam attorneys will: 

  • Investigate and collect evidence to prove healthcare fraud 
  • Conduct interviews, obtain documents, and analyze data to build a strong case
  • Draft and file a complaint that meets FCA’s requirements
  • Represent you in court and advocate for your interests
  • Negotiate with the government to ensure you receive a fair share of any recovery

Above all, we will work strategically to protect your rights and get the maximum reward permitted by law.

Representing Whistleblowers In Qui Tam Claims 

Coming forward to report healthcare fraud takes courage, but it’s the best way to ensure the viability of the Medicare and Medicaid programs. If you have evidence of fraud against the government, contact Levy Goldenberg today.