Healthcare Fraud Is the Leading Type of Federal False Claims Act Case
In San Bernardino and across California and the nation, whistleblowers have the right to a percentage of any recovery if they properly disclose healthcare fraud which is then used by the Department of Justice (DOJ) to prosecute wrongdoers.
According to 2018 DOJ summaries of False Claims Act cases:
“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.”
At Stephen Danz & Associates, San Bernardino California whistleblower lawyers, our lawyers have the experience and resources to help you properly file your disclosure claim and to work with the DOJ prosecution team.
Healthcare fraud in San Bernardino
The Federal False Claims Act helps citizens and the government protect the following federal agencies from billing fraud:
- Medicare and Medicare Part D (the drug part of Medicare)
- TRICARE – the government program for retired military families and their families
Types of healthcare billing fraud
Nurses, doctors, pharmaceutical reps, managed care advisers, and anyone who is aware of any of the following types of dishonest actions by a healthcare provider or company may have a False Claims Act case:
- Charging for services, medications, and treatments that aren’t necessary
- Billing for services, drugs, and treatments that were never performed
- Upcoding – a way of overcharging for services and treatments
- Misrepresenting the certifications and credentials of staff members
- Redlining – another way of improperly taking advantage of the billing process by favoring healthy patients over patients who are ill.
- Inflating the cost of overhead
Big Pharma fraud
Drug manufacturers who commit the following acts may be required to defend a False Claims Act:
- Off-label marketing. Here, drug companies try to get doctors to recommend their medications even though the FDA labels do not approve of the intended use of the drug.
- Illegal incentives. Drugmakers can’t bribe or offer financial rewards to doctors, managed care facilities, and hospitals for prescribing their medications
- Violating Medicaid’s price violations. Drugmakers are required to offer the drugs to Medicaid at the best possible price – cheaper or the same as what they offer to private companies.
Other pharmaceutical fraud includes non-compliance with FDA rules and inflating the price of the drugs.
Stark Law and the Anti-Kickback Statute (AKS) were enacted to protect patients. Doctors cannot refer patients to testing facilities, medical device makers, and other doctors – if the doctor has a financial incentive to make the referral.
Stark law provides that doctors can’t refer patients to a facility where the doctor (or a family member) has a financial interest in the facility. The AKS forbids referrals if the facility offers the doctor cash or some other financial benefit. There are some exceptions where referrals may be legal – generally, if they are based on a legitimate medical need.
Violations of Stark Law and the AKS are also considered violations of the False Claims Act.
Research and development fraud in San Bernardino
Universities and private companies who apply for government grants who receive any federal benefit must act truthfully with the agency that provides the grant or benefit. Examples of R&D fraud include:
- Altering data and test results
- Not providing accurate information on the grant proposal
- Overbilling for expenses
- Not complying with research safety protocols
- Not using the money received for the intended purpose
Healthcare fraud costs the American public a fortune. At Stephan Danz & Associations, our San Bernardino lawyers are dedicated to helping whistleblowers disclose this fraud. We work aggressively to protect your claim to a percentage of the recovery. If you think you have a whistleblower claim, call us at (877)789-9707 or complete our contact form to make an appointment. Se habla espanol.