Pasadena Health Care Fraud Lawyers When Employers Violate the Federal False Claims Act
Pasadena, like most of California, has wonderful medical services. Unfortunately, Californians and the rest of the country do try to take advantage of many government programs. The whistleblower provisions of the federal False Claims Act help whistleblowers stop fraud by offering them a percentage of any valid recovery.
According the Department of Justice:
“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. The recoveries included in the $2.5 billion reflect only federal losses but, in many of these cases, the Department was instrumental in recovering additional millions of dollars for state Medicaid programs.”
“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 Pasadena California whistleblower lawyers are strong advocates for nurses, doctors, pharmaceutical workers, managed care workers, and anyone who discloses fraud involving Medicare, Medicare Part D, Medicaid, and TRICARE.
Common types of healthcare billing fraud
Some of the many ways doctors, hospitals, nursing homes, and other commit healthcare fraud (which can justify a False Claims Act case) include:
- Billing for patients that don’t exist
- Billing for treatments that were never given or weren’t medically necessary
- Falsifying credentials and certifications
- Inflating the cost of overhead
Pharmaceutical manufacturers fraud
To make up for their large investments, pharmacy companies do try to game the system in the following ways:
- Not offering Medicaid the best price available – better or the same as what they offer private companies
- Offering illegal kickbacks such as cash or lush vacations and meals to doctors to get the doctor to prescribe their medications
- Violating the label requirements of the FDA by inducing doctors to make “off-label” recommendations – recommendations that aren’t part of the FDA label requirements
- Inflating the price of their drugs
- Not comply with best manufacturing practices and other FDA requirements
There are two federal laws, Stark Law and the Anti-Kickback Statute (AKS), that regulate physician referrals. The laws require that referrals be based on what’s best for the patient and not on any financial incentive the doctor has.
The AKS prohibits kickbacks such as cash, paying doctors for speeches and board services above fair market value, expensive lunches, and other benefits to get the referral.
Stark Law prohibits referrals where the doctor or a family member has an investment or financial stake in the doctor or company that is receiving the referral.
Stark and AKS violations are grounds for a False Claims Act violation.
Research and development fraud
Universities and private companies that seek government grants can’t lie on their grant applications. They can’t fudge/alter the data, they can’t use the funds for un-related purposes, and they can’t overcharge for expenses. Government backed research should benefit the public, not the schools or companies.
To speak with an experienced Pasadena healthcare fraud lawyer, call the experienced Pasadena law offices of Stephen Danz & Associates. We’ve been fighting for workers and the public for nearly 40 years. You can call us at (877)789-9707 or complete our contact form to make an appointment. Se habla espanol.