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Healthcare Fraud

You can blow the whistle and stop the fraud, and if done correctly, you can receive part of the recovery.

The cost of health care in this country is astounding, and it continues to rise. One of the contributing factors to the increase in healthcare costs is fraud. According to the Department of Justice, in 2017, $2.4 billion dollars was recovered from those who defrauded the government.

If you have witnessed or have knowledge of fraud against government, federal or local, and want to see the fraud stopped - YOU can do something about it.

Medicaid & Medicare Fraud

Most healthcare fraud stems for 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

Kickbacks in the medical community are considered false claims under the False Claims Act.  The Anti-Kickback Statute is a federal statute that prohibits giving and receiving any form of payment (remuneration) in exchange for referring a service or a product.

Stark Law is a set of federal laws that prohibit physicians from self-referring.  Under Stark Law, a physician is prohibited from referring a Medicare or Medicaid patient to a provider if that physician, or immediate family member, has a financial interest or relationship with them.

Pharmaceutical Fraud – Big Pharma

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 sone 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 includes any illegal practice that involves the manufacturing, production, marketing, or promotion of drugs that result in payment by a governmental program, like Medicaid or Medicare.

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

Whistleblower Protection

Reporting fraud can be risky. Retaliation by an employer is a legitimate concern for any whistleblower. Fortunately, the False Claims Act gives the whistleblower protection. For example, the FCA protects a whistleblower from denial of promotions, demotions, reduction in working hours, suspensions, and isolation from meeting or projects.

Free Consultation

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

Resources

Find Out How We Can Help You

At Miller Law Group, PLLC, we are guided by the principle of attaining justice for people who have been wronged in their personal or professional lives. To learn more about our services or to schedule a free initial consultation, contact us today by calling 919-348-4361 or by email. We look forward to making you a part of our team.

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While this website provides general information, it does not constitute legal advice. The best way to get guidance on your specific legal issue is to contact a lawyer. To schedule a meeting with an attorney, please call or complete the intake form below.
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