Federal False Claims Act and Fresno Health Care Fraud Lawyers
The Federal False Claims Act (FCA) is an old law that aims to help the government recover from individuals and companies that cheat the government by submitting false bills. Individuals who disclose fraudulent acts by an employer or by a company they work with are entitled to a share of the recovery which can be as high as 30%. Recoveries include statutory fines which can be quite high plus the amount of the fraud.
Our Fresno California whistleblower lawyers have a strong record of success filing and pursing whistleblower claims for various types of fraud. Healthcare fraud is one of the major types of fraud types we handle.
Healthcare fraud in Fresno
The US Department of Justice with the help of private citizens brings False Claims Act cases when federal agencies are affected. We help nurses, technicians, contractors, doctors, and others recover when pharmacies, drug manufacturers, hospitals, and physicians submit false claims.
The Federal False Claims Act covers many types of false claims including:
- Claims for payment submitted to Medicare
- Claims to Medicare on behalf of low-income patients and SSDI patients
- Medicare Part D drug claims
- Tricare claims for retired military personnel and their families
How health providers try to cheat the government
Health care providers such as physicians and hospitals submit false claims in many different ways. Often, they submit multiple false claims so that the individual billing doesn’t stand out. Examples of False Claims Act fraud bills that are illegal include:
- Charging for tests and treatments that are not medically necessary
- Charging for ghost patients
- Charging for services that were never performed on a patient
- Falsifying information such as certifications
- Upcoding bills to charge for more expensive services and treatments
- Inflating overhead costs
- Favoring healthier patients at the expense and care of less healthy patients
Many makers of drugs try to take navigate around FDA and other laws which regulate their approval and distribution. Some of these techniques include:
- Off-label marketing. Here, the pharmacy companies try to get doctors to recommend and use their drugs when they know that the labels (uses) of the drugs have been restricted by the FDA. Physicians can prescribe uses beyond the label requirements – thus, the term – “off-label marketing.
- Illegal kickbacks. As we explain below, there are laws which regulate giving physicians and hospitals inducements to favor the company, such as a drug manufacturer, over competitors or – most importantly – over doing what’s best for the patient.
- Best price violations. Pharmacies are required to offer Medicaid the best price that they offer the private companies they work with. Some unscrupulous drug makers say they’re offering the best price and then charge private companies less.
Other types of pharmaceutical fraud include inflating the price of the drugs and violating the FDA’s requirements for good manufacturing practices.
Some hospitals and doctors refer patients and refer health care products and companies because they have a financial incentive. Stark Law and the Anti-Kickback Statute are designed to ensure that patient care and safety comes before any medical profit.
Both laws seek to regulate physician relationships with other health providers and companies. Unless there is an exception or a safe harbor, doctors generally cannot refer business to another doctor, a hospital, labs, or other health companies:
- If they have a financial interest in the company, they refer the patient to
- If they received a financial incentive such as a cash payment, a lucrative lunch, or a speakership at above fair market value rates.
Both laws govern relationships where bills are submitted to Medicare and Medicaid. The AKS also governs billing to other federal agencies.
Research and development fraud
Universities and private companies often rely on government grants and tax credits in order to fund their research. While the government encourages quality research, the grant applicant must be honest in its dealings with the government. Examples of dishonest claims, which can be the basis for a False Act claim, include:
- Giving false information to obtain the grant
- Falsifying data and results
- Overcharging for expenses
- Not using the grant funds for the intended purpose
- Not complying with safety requirements
Healthcare fraud costs the public a lot of money. It endangers patient care. If you are aware of fraud in the healthcare sector, our Fresno False Claims Act lawyers will explain if you have a valid claim. We’ll work with you to persuade the Department of Justice to accept your claim. To speak with a strong advocate, call the experienced Fresno law offices of Stephen Danz & Associates today. We’ve been fighting for justice for nearly 40 years. You can reach us at (877)789-9707 or complete our contact form to make an appointment. Se habla espanol