Most people knowledgeable of fraud against the government are inside employees who are afraid of losing their job if they report fraudulent conduct by their employer. Those benefiting from the fraud rarely tell on themselves, but often rely on lower level employees to carry out the fraudulent scheme. Realizing that most fraud against government programs goes unreported, lawmakers created a law to encourage individual(s) to report fraud.
The False Claims Act was created to incentivize whistleblowers to report fraud by allowing whistleblowers to receive a percentage of any recovery, while also protecting whistleblowers from workplace retaliation. The FCA allows whistleblower claims, called Qui Tam lawsuits, to be filed under seal, meaning in secret, to allow the government the opportunity to intervene. If the government intervenes, the government prosecutes the claim and the whistleblower is award up to 25% of any recovery.
The most common areas of fraud against the government are Healthcare Fraud and Government Contract Fraud. Without getting too detailed, the “fraud triangle” has been often referred to as the root of fraudulent conduct. The fraud triangle is: “pressure” which results in irrational behavior; “opportunity” or access to commit fraud – often a position of trust; and “rationalization” that the wrongful actions are justified.
In 2018, the Department of Justice recovered $2.9 billion under the False Claims Act, with $2.5 billion attributed to the healthcare industry. The federal healthcare programs that are defrauded the most are the Medicare and Medicaid programs. The most common types of Medicare and Medicaid fraud are:
- Up coding
- Unbundling
- Billing for Services Not Rendered
- Billing the Medically Unnecessary Service
- Falsifying Patient Diagnosis to Justify Tests
- Accepting Kickbacks for Patient Referrals
- Waiving Co-pays or Deductibles
Healthcare companies should develop detailed compliance plans and policies for proper billing practices, and engage in regular comprehensive audits to mine out billing mistakes and irregularities.
If you suspect that your employer is committing fraud against the government, it is important to speak with an experienced whistleblower lawyer prior to reporting the fraud. Whistleblowers can waive their rights under the False Claims Act if they do not follow the Act correctly. Because a whistleblower is representing the federal government in the claim, the law requires a whistleblower to have legal representation. An experienced whistleblower lawyer will know how to protect the whistleblower’s rights and recovery.
The lawyers with Miller Law Group have experience representing whistleblowers in various Healthcare and Government Contracting fraud cases under the False Claims Act. Miller Law Group has offices in Raleigh, NC, Columbia, S.C., and Washington DC. W. Stacy Miler, II, the founding member of the firm, – “It takes courage to be a whistleblower, and I’m honored to represent to represent them.”
