Bakersfield Lawyers Who Represent Whistleblowers in Healthcare Fraud Cases through the Federal False Claims Act
The Federal False Claims Act (FCA) was enacted back in the days of Abraham Lincoln to help the government collect from federal contractors who cheated the US Defense Department. The FCA has been expanded to include any healthcare claims involving government agencies such as Medicare and Medicaid. The False Claims Act also includes provisions authorizing a payment of up to 30% of any recovery when a whistleblower’s disclosure leads to a recovery. The recovery includes heavy fines in addition to a return of the ill-gotten gains.
Our Bakersfield California False Claims Act lawyers have been fighting for employees who step forward and disclose employer wrongs for nearly 40 years. We represent contractors and non-employees, in addition to employees, who disclose healthcare fraud.
Healthcare fraud in Bakersfield
A nurse, technician, vendor, doctor, administrator, or anyone who knows that a health provider or healthcare company is submitting false bills can file a False Claims Act case with the US Department of Justice. Experienced Bakersfield attorneys will guide you through the disclosure process and the litigation process. We fight to protect your share of any recovery.
Some of the federal agencies that process and pay health care claims include:
- Medicare, which is a program for seniors
- Medicare, a program for low-income families and for SSDI patients
- Medicare Part D claims
- Tricare, a program for retired military personnel and their spouses and children
The ways in which medical businesses submit false bills
The American taxpayer and medical patients rely on doctors and hospitals to submit accurate bills. Otherwise, taxes go up and medical costs go up. Whistleblowers provide a valuable service to the public when they disclose health care fraud. Some of the types of fraud associated with false billing claims are:
- Having the patient take unnecessary medical tests or treatments
- Upcoding – the act of using a code for a medical test or service that costs more than is necessary
- Providing false information including false certifications
- Charging for patients who don’t exist
- Inflating the cost of overhead
Types of Big Pharma fraud
Drug manufacturers sometimes try to increase the return on their investment by skirting FDA guidelines, and charging more than they should. A few techniques pharmaceutical makers use to cheat the government and the public include:
- Off-label marketing. Big pharma knows that the drugs it designed should only be sold for their approved purposes – the purposes on their label. To get around this duty, some pharma companies induce doctors to prescribe their drugs to patients for uses that are off-label (beyond the FDA required uses). Doctors have some discretion in which drugs they advise patients to use but the discretion can’t be due to pharmaceutical companies lining their pockets
- Illegal kickbacks. Stark Law and the Anti-Kickback Statute, discussed below, regulate the financial incentives that pharmacies can give doctors and how doctors refer patients to pharmacies.
- Medicaid price violations. Pharmacies that work with Medicaid can’t charge Medicaid more than they do the private companies they work with. Some pharma companies say they’re giving Medicaid the best price -when they aren’t.
Stark and AKS anti-Referral laws
Stark Law and the Anti-Kickback Statute regulate physician referral arrangements when those doctors or the companies they refer business to – bill government agencies such as Medicare and Medicaid.
Stark law generally regulates any doctor-facility relationship where the doctor (or a family member) has a financial interest in the facility. Facilities include lab testing facilities, other medical practices, and other healthcare suppliers and companies.
The AKS regulates the financial incentives companies can give to doctors in return for having the doctor refer their business. For example, the pharmacy kickbacks discussed earlier.
Illegal financial incentives generally include cash payments, vacations, surreptitious arrangements, and other contracts – where the person/company paying the incentive expects that the health provider (doctor or hospital) will refer them business.
Violations of Stark and the AKS are grounds for filing a False Claims Act case.
Private companies and colleges depend on federal grants to fund their research when private investors can’t be found. The grant applications and grant research must be honest though. If grants are based on any of the following, a False Claim Act case may be needed to force a return of the grant funds:
- Giving dishonest information to get the grant
- Overcharging for research costs
- Using data that is false or submitting false results
- Using the grant funds for non-approved purposes
- Not meeting safety protocols
The experienced Bakersfield law offices of Stephen Danz & Associates have the experience and resources to help whistleblowers file correct disclosures and obtain the False Claims Act recoveries they deserve. To learn how to file a whistleblower claim for healthcare fraud, call us at (877)789-9707 or complete our contact form to make an appointment. Se habla espanol.