Healthcare Fraud Lawyers

In Raleigh, Durham, Cary, & Beyond

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Find Out How To Receive Part Of The Recovery

You Can Blow The Whistle And Stop The Fraud

The cost of health care in this country is truly astounding, and unfortunately, it shows no signs of slowing down. One of the significant factors that contribute to the incessant rise in healthcare costs is the rampant issue of fraud. According to the Department of Justice’s report from 2017, an astonishing $2.4 billion dollars was successfully recovered from those who shamelessly defrauded the government. This staggering figure serves as a testament to the urgent need for stricter regulations and enhanced measures to combat this pervasive problem and ensure the affordability and accessibility of quality healthcare for all.

If you have personally witnessed or possess valuable knowledge regarding fraudulent activities against the government, whether at the federal or local level, and you have a strong desire to put an end to these deceitful acts – YOU have the power to take action and make a difference. It may be time to reach out to a healthcare fraud lawyer. By speaking up and reporting the fraud, you can contribute to the safeguarding of public resources and the promotion of integrity and accountability in our society. Your courage and commitment to justice can help ensure a fair and transparent government for all.

Find Out How We Can Help You

If you are aware of fraud or illegal activity being conducted against the government and want to make a difference, contact Miller Law Group for a free consultation.

Medicaid & Medicare Fraud

Types Of False Claims

Most healthcare fraud stems from improper billing for Medicaid and Medicare programs. If a provider (for example, a hospital) intentionally or negligently makes a false statement in an effort to be reimbursed under the Medicare or Medicaid program, the provider could be subject to a claim under the False Claims Act (FCA). Depending on the conduct of the provider, the provider could be subject to treble damages under the FCA.

The most common types of false claims are:

  • Billing for medically unnecessary services
  • Up coding, Double-billing, Unbundling
  • Billing for services not provided
  • Accepting kickbacks
  • False price and cost reports
  • Beneficiary not eligible for reimbursement
  • Inadequate medical documentation

Anti-Kickback & Stark Law

Referring Services, Products, and Physicians

Kickbacks in the medical community are considered false claims under the False Claims Act. The Anti-Kickback Statute goes even further by prohibiting the exchange of any form of payment or remuneration in return for referring a service or a product. This means that healthcare providers cannot receive kickbacks or incentives for recommending specific treatments, medications, or medical devices. These laws aim to ensure that healthcare decisions are made in the best interest of patients, free from any improper financial influence or conflicts of interest.

Stark Law is a set of federal laws that prohibit physicians from self-referring. These laws specifically prohibit physicians from referring Medicare or Medicaid patients to healthcare providers with whom they have a financial interest or close relationship, such as an immediate family member. This measure ensures transparency, integrity, and fairness in the healthcare system, safeguarding the interests of patients and promoting ethical medical practices.

Pharmaceutical Fraud – Big Pharma

Pharmaceutical Fraud – Big Pharma

Common Forms Of Medical Fraud

Pharmaceutical companies are responsible for some of the largest whistleblower cases under the False Claim Act. GlaxoSmithKline agreed to a $3 billion dollar settlement in 2012, while Pfizer promised to pay $784 million in 2016. Drug companies and the pharmaceutical industry are some of the wealthiest sectors in the U.S. economy. Annual sales are projected to be in excess of over a trillion dollars in 2018.

Pharmaceutical fraud encompasses a wide range of illicit activities related to the manufacturing, production, marketing, or promotion of drugs. These fraudulent practices aim to exploit governmental programs, such as Medicaid or Medicare, leading to unauthorized payments. Such illegal actions can involve various deceptive tactics, including falsifying drug efficacy, misrepresenting clinical trial results, or engaging in off-label promotion. Detecting and combating pharmaceutical fraud is crucial to safeguarding public health and ensuring the integrity of healthcare systems.

The most come forms of pharmaceutical fraud are:

  • Off label promoting and marketing
  • Illegal kickbacks
  • Falsifying data and studies
  • Best Price Rule
  • Violating FDA regulations
Investigator looking into healthcare fraud documents

Whistleblower Protection

How To Protect Against Retaliation

Reporting fraud can be a risky task. Whistleblowers often face the legitimate concern of retaliation from their employers. However, there is a ray of hope in the form of the False Claims Act (FCA), which provides protection to those brave enough to expose fraudulent activities. Under the FCA, whistleblowers are shielded from various forms of retaliation, including denial of promotions, demotions, reduction in working hours, suspensions, and even being isolated from important meetings or projects. This protection ensures that whistleblowers can come forward with confidence, knowing that their rights and well-being are safeguarded. A healthcare fraud lawyer at Miller Law Group can help you navigate through it all.

About Miller Law Group

Raleigh Based Skilled Attorneys

Miller Law Group is based in Raleigh, North Carolina, dedicated to championing the rights and freedoms of individuals. Our firm comprises a team of highly skilled and experienced healthcare fraud attorneys. We are driven by a commitment to justice and are passionate about representing clients facing healthcare fraud claims. With over 150 years of combined experience, our award-winning attorneys have a proven track record of tackling healthcare fraud cases. Our firm is not just about work; we have a deep love for our community and invest time and resources in serving and uplifting Raleigh. At Miller Law Group, our aim is to provide exceptional service and to partner with our clients in navigating their legal journeys.