Sacramento Whistleblower Federal False Claims Attorneys

Healthcare Fraud in Sacramento and the Federal False Claims Act

The Department of Justice reported recently these astounding facts regarding the False Claims Act and the healthcare sector:

  • “Of the $2.8 billion in settlements and judgments reported by the government in the 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.”
  • “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.”
  • “The Department’s health care fraud enforcement efforts recover money for federal programs that fund health care for our nation’s most vulnerable and deserving citizens, such as Medicare, Medicaid, and TRICARE.  But just as important, the Department’s vigorous pursuit of health care fraud prevents billions more in losses by deterring those who might otherwise try to cheat the system for their own gain.”

Our Sacramento California whistleblower lawyers have a strong record of success representing whistleblowers throughout California.

Ways in which healthcare fraud occurs

Doctors, managed care providers, labs, hospitals, and others commit a violation of the False Claims Act if they:

  • Submit bills for services, tests, or treatments they never provided
  • Overcharge for their services or upcode their services
  • Charge for services, tests, or treatments that were not medically necessary
  • Create imaginary patients
  • Inflate the costs of overhead
  • Present false certifications or credentials
  • Redline sick patients in favor of healthy patients

Fraud by drug makers

Drug manufacturers can’t induce (through cash incentives or other benefits) doctors to favor their drugs over drugs from other companies or over non-prescription treatments. The inducements may qualify as illegal kickbacks. If they are meant to get around FDA labeling requirements, the inducement may be considered illegal “off-label” marketing.

Drug makers must offer Medicaid their best price for their drugs and must comply with FDA rules.

The DOJ report mentioned above, for example, found that:

“In one matter, AmerisourceBergen Corporation and certain of its subsidiaries paid $625 million to resolve allegations that they sought to circumvent important safeguards intended to preserve the integrity of the nation’s drug supply and profit from the repackaging of certain drugs supplied to cancer-stricken patients. Of that amount, $581.8 million was paid to the federal government and $43.2 million was paid to state Medicaid programs.”

Anti-Referral laws – Stark and the Anti-Kickback Statute (AKS)

Congress passed Stark and the AKS to ensure that doctors and other health providers refer patients to other doctors, to pharmacies, to lab facilities, to medial device makers, and others – based on the quality of the service or product. Referrals should not be made to benefit the physician’s finances.

Referrals based on a kickback (cash payment or other financial payment) or based on the doctor having a financial investment in the business that the doctor recommends are generally a violation of the AKS, Stark Law, or both. There are exceptions that are based on a showing that the referral is for a just medical business need. Violations of the AKS or Stark are generally considered to be a valid reason to file an FCA case.

Research and development fraud

Schools and private R&D companies who apply for government grants or receive other federal benefits must deal with the government honestly and fairly. Examples of R&D fraud include:

  • Not telling the truth on the government grant application
  • Not using the funds for the approved research and development
  • Changing data or results to achieve a better outcome
  • Not complying with safety requirements
  • Misrepresenting the overhead costs

Healthcare fraud, as the DOJ report confirms, is a multi-billion dollar business. Anyone in Sacramento or California who is aware of healthcare fraud should contact the experienced Sacramento law offices of Stephen Danz & Associates. We’ve been fighting for employees and whistleblowers for nearly 40 years. You can reach us at  (877)789-9707 or fill out our contact form to make an appointment. Se habla espanol.