The Federal False Claims Act and Orange County Health Care Fraud Lawyers
The Federal False Claims Act (FCA) is a law Congress enacted back in the days of President Abraham Lincoln to help the government prosecute fraud. It has been expanded to allow whistleblowers who properly disclose fraud to collect a percentage of any recovery, sometimes up to 30%. The FCA is used for various types of fraud including healthcare fraud. The agencies that the law protects include:
- Medicare for seniors
- The Part D Medicare prescription drug plan
- Medicaid for low-income people
- TRICARE for retired military personnel and their families
Our Orange County California whistleblower lawyers have been fighting for employees including those who disclose fraud by their employer for 40 years. We also represent nurses, doctors, marketing reps, managed care personnel, and others who disclose fraud even if they are not an employee
Types of healthcare fraud in Orange County
Anyone in Orange County who observes the following types of fraud may have a valid False Claim Act qui tam action:
- Doctors, managed care facilities, hospitals or others who charge for services and treatments that aren’t reasonably medically necessary
- Health providers who bill for services and treatments they never provided
- Creating ghost accounts and submitting claims through them
- Lying about or misrepresenting staff medical credentials
- Inflating overhead expenses
- Upcoding bills to receive a bigger payout
- Redlining – discriminating in favor of healthier patients when fees are based on a set amount no matter the health/illness of the patient
Pharmaceutical fraud In Orange County
Makers of medications can’t do any of the following in order to get physicians or other qualified personnel to prescribe the drugs they make”
- Fail to offer Medicaid the best available price
- Offer illegal incentives such as cash benefits or above fair market value benefits to doctors to prescribe the manufacturer’s drugs
- Try to navigate around the FDA labeling requirements by offering incentives to doctors who prescribe “off-label” uses for their patients
Stark Law is a set of laws that regulates referrals by doctors. It provides that a doctor cannot refer a patient to a medical business or facility in which the doctor (or a family member of the doctor) has a financial interest in. There are exceptions for medical needs that are detailed in the statute.
The Anti-Kickback Statute (AKS) provides the referrals must be legitimate too. Doctors can’t make referrals in return for a cash payment, for getting business in return based on the volume of the referrals, for lavish lunches or vacations, or other unjustified benefits. The AKS has safe harbors for valid medial reasons.
Violations of Stark Law and the AKS are generally considered violations of the False Claims Act. Many healthcare companies have been found in violation of either Stark or AKS or both.
Both statutes apply to bills submitted to Medicare and Medicaid. The AKS also regulates bills to other federal agencies such as TRICARE.
Research and development fraud
Universities and private businesses that do healthcare research may be in violation of the False Claims Act if:
- They provide false information in the grant
- They use the grant funds for non-grant purposes
- They change the results from what the data supports – in order to justify the grant or get more grant funds
- They overbill for expenses
- They fail to follow other federal laws such as those that govern the Federal Drug Administration (FDA).
If you suspect your employer or someone your employer does business with is committing healthcare fraud, our Orange County False Claims Act lawyers can help you evaluate and pursue your right to file a whistleblower action. To speak with an aggressive FCA lawyer, call the experienced Orange County law offices of Stephen Danz & Associates. You can call us at (877)789-9707 or complete our contact form to make an appointment. Se habla espanol.