Experienced Los Angeles Federal False Claim Act Lawyers for Healthcare Fraud Claims
The Federal False Claims Act (FCA) is a law used by the Department of Justice to prosecute fraud against the government. The leading industry sector for healthcare fraud and whistleblower claims is healthcare fraud involving Medicare, Medicaid, Medicare Part D, and TRICARE. According to the DOJ’s 2018 fiscal year study:
- “Of the $2.8 billion in settlements and judgments recovered by the Department of Justice this past fiscal year, $2.5 billion involved the health care industry, including drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians. This is the ninth consecutive year that the Department’s civil health care fraud settlements and judgments have exceeded $2 billion.”
- “Of the $2.8 billion in settlements and judgments reported by the government in fiscal year 2018, over $2.1 billion arose from lawsuits filed under the qui tam provisions of the False Claims Act. During the same period, the government paid out $301 million to the individuals who exposed fraud and false claims by filing these actions.”
Our Los Angeles California whistleblower lawyers guide whistleblower’s through the False Claims Act process by explaining which disclosures the DOJ will review and then preparing the correct document sand the most persuasive argument possible for the DOJ.
Types of healthcare billing fraud
Our Los Angeles FCA lawyers help nurses, doctors, marketing reps, and others analyze all types of health fraud including:
- Billing for services that the patient doesn’t need
- Billing for services to fictional patients
- Charging for treatments and services that were never performed
- Upcoding bills to receive a higher reimbursement
- Redlining – favoring healthy patients over sick ones so the doctor can do less work for the same fee
- Falsifying credentials
- Charging more overhead costs than is justified
Fraud by drug makers
Pharmaceutical manufacturers must deal honestly with the health professionals and companies they work it. It is generally not legal, and thus a violation of the FCA, to:
- Offer kickbacks to doctors so the physician will favor their drugs over those made by other companies or over non-prescription treatments
- Not offer the best available price to Medicare
- Trying to get doctors (who can prescribe drugs for uses not listed on the drug’s FDA labels) to prescribe their drugs for those “off-label” uses.
- Providing drugs that don’t comply with FDA requirements
Stark Law and the Anti-Kickback Statute (AKS)
Congress enacted two laws to protect patients when doctors refer them to other doctors, to hospitals, to lab-testing facilities, and to other health companies. Doctors should make the referral based on what’s best for the patient. Some doctors make referrals based on their own financial incentive – which is typically a violation of the one these anti-referral laws and the False Claims Act.
Stark Law reviews whether the doctor (or a family member of the doctor) has a financial interest in any of the health entities he/she refers patients to. Generally, referrals to facilities where there is a financial interest are illegal – unless some legitimate exception applies.
The AKS protects patients from referrals that are made because the doctor is receiving cash, expensive meals, or unwarranted benefits – from the lab, doctor, or entity that the doctors is referring the patient to.
The government relies on grant applicants to be honest on their application and that the research results be accurate. Universities and private companies must also use the grant funds for the approved research and not other purposes. They can’t claim more expenses than they have.
When the grant recipient cheats in any way, they may be subject to a False Claims Act case.
Healthcare fraud in Los Angeles and across California costs the taxpayers millions and millions. Our Los Angeles False Claims Act lawyers understand whistleblower law. We understand the criteria the DOJ is looking for to decide to intervene on your behalf. To learn your whistleblower rights, call the experienced Los Angeles law offices of Stephen Danz & Associates. We’ve been fighting for justice for nearly 40 years. You can call us at (877)789-9707 or use our contact form to make an appointment. Se habla espanol.