Filing a Healthcare Based Federal False Claims Act in San Francisco
The Federal False Claims Act (FCA) serves the government and the American taxpayer by rewarding whistleblowers who disclose false bills and other dishonest acts by those who contract with the government. While the FCA and similar whistleblower lawyers work to force cheaters to return ill-gotten gains in the financial, tax, energy, and other sectors – it is healthcare fraud that is one of the biggest areas where fraud occurs.
The FCA is a law which gives the US Department of Justice the right to seek repayment of any illegal payments – along with statutory fines for each violation.
Our San Francisco California whistleblower lawyers have been pursuing FCA cases for nearly 40 years. We’ll guide you through the disclosure process and the litigation process.
Healthcare fraud in San Francisco
There are numerous types of healthcare fraud. Healthcare businesses that have been charged with committing fraud including doctors, hospitals, and pharmaceutical companies. The US government relies on technicians, doctors, nurses, suppliers, and anyone who knows of any healthcare fraud to notify the government, with the help of legal counsel, of any fraud. Companies and individuals can be held accountable if they submit false claims to:
- Medicare or Medicaid – the agencies that serve seniors, low-income people, and others
- Tricare – the agency that provides public insurance for retired members of the military and their families
- Medicare Part D – a federal drug program
Different types of physician and hospital healthcare fraud
There are numerous ways doctors and hospitals and other health providers submit false claims. Some of the best know fraudulent schemes are:
- Ordering services a patient didn’t need
- Upcoding – so that Medicare, Medicaid, or an insurer pays for a more expensive procedure than was required or done
- Billing for patients who aren’t real – just computer entries
- Charging more than what is standard for a particular treatment
- Lying about certifications
- Inflating costs for utilities and other overheard needs
- Redlining – the act of favoring patients who are healthy over those in need
Drug makers sometimes try to entice doctors and hospitals to use their drugs for conditions even though their drugs don’t have the proper approval or when other cheaper drugs would be just as effective. Pharmacy fraud includes:
- Illegal inducements. Some pharmaceutical makers offer cash and other incentives to encourage doctors and hospitals to use their drugs.
- Off-label marketing. The FDA regulates what conditions drugs should be used to treat through a labeling process – drug x is approved for condition y. Doctors have more discretion. If they think a drug is effective for a condition that hasn’t been approved (isn’t on the label), they can make an off-label recommendation. Drug makers sometimes try to persuade the doctors and hospitals to make off-label recommendations. When a pharmacy submits a bill to Medicare or another agency for off-label drugs, it’s generally not legal if the reason for the doctor recommendation was that the drug maker improperly induced the doctor to recommend the off-label drug.
Pharmacy fraud also includes best pricing violations where the drug makers promises Medicaid they’ll be getting the pharmacy company’s best price for the drug – when Medicare isn’t getting the best price. There are other types of pharmacy schemes that violate the FCA which a skilled whistleblower lawyer can explain.
Congress wanted to make sure that when doctors and hospitals recommend/refer patients to other doctors, to lab testing facilities, or for other medical services – that the referral is based only on what’s best for the patient. Referrals shouldn’t be based on what’s good for the doctor or hospital. That’s why they enacted Stark Law and the Anti-Kickback Statute.
Stark Law and the Anti-Kickback statute are similar but not identical laws which regulate what referrals are legal and which ones aren’t. If a health practice or company violates Stark Law or the AKS, the government can file a False Claims Act case.
Fraud – Research and development
The government provides grants and tax credits to private researchers and university researchers based on the submission of grant applications. An FCA claim can be brought against the applicant if:
- The information on the application was false
- The grant funds were used for non-grant purposes
- The researchers alter the data or the results
- The researchers overbill for costs
- There are other dishonest transactions
If you have reason to believe a medical practice, a hospital, a contractor, a pharmacy, or any other health company is not submitting bills that are true, you may have a valid whistleblower claim. To learn your rights and to speak with an experienced lawyer, call the experienced San Francisco law offices of Stephen Danz & Associates today. We have the skills and resources to help you get justice. You can reach us at (877)789-9707 or fill out our contact form to make an appointment. Se habla espanol.