Our healthcare system is charged with providing care to those in need of medical assistance – but far too often we find cases of healthcare administrators and doctors participating in widespread schemes to bilk money out of the federal government and the Medicare/Medicaid system. If you have information pertaining to any such scheme involving Medicare or Medicaid fraud, contact an attorney from Altman & Altman LLP right away to help you become a whistleblower, as it could mean a significant financial reward if your information leads to the uncovering of fraudulent behavior.
Medicare fraud can occur anywhere
As long as there exists a financial incentive for doctors and healthcare administrators to fraudulently charge for services they never rendered, or falsely inflate the cost of services to receive more money from the government, Medicare and Medicaid fraud will unfortunately continue to happen.
Recently, the U.S. Department of Justice announced that Laboratory Boston Heart Diagnostics Corporation of Framingham agreed to pay a settlement of nearly $27 million in response to allegations that they improperly billed the Medicare, Medicaid and TRICARE programs for lab tests. Those overbillings were then kicked back to doctors disguised as “investment returns,” per reports.
The report goes further, documenting a comprehensive scheme in which the company provided testing services to smaller hospitals from Texas on a pay-per-test basis, and then worked with those hospitals’ marketing agents to pay doctors who referred certain lab tests to be conducted. Essentially, the company allegedly and illicitly paid doctors to recommend specific tests, which the company could then bill the federal government for. The company also allegedly was involved in submitting outpatient claims on patients who were not hospital outpatients – which is known as false billing.
Boston Heart Diagnostics is not the only Massachusetts company to get caught in such a scheme. In 2010, the Woburn-based Calloway Laboratories Inc. was indicted on 42 counts of Medicaid fraud, which included sending kickbacks and accruing over $10 million in funds from the state Medicaid program MassHealth to obtain drug screening business for itself.
Whistleblowing is an essential tool to root out this corruption
Under the False Claims Act, whistleblowers can expose persons and companies that defraud the federal government – or federal programs run by the government, such as Medicare and Medicaid. This is called a qui tam action.
Whistleblowing – the act of alerting federal authorities to schemes in which individuals or companies are actively defrauding the government – is a protected act that can result in large financial rewards if a whistleblower’s report results in a successful case or settlement against the entity that is accused. According to the National Whistleblower Center:
“Under Section 3730(h) of the False Claims Act, any employee who is discharged, demoted, harassed, or otherwise discriminated against because of lawful acts by the employee in furtherance of an action under the Act is entitled to all relief necessary to make the employee whole. Such relief may include:
- Double back pay
- Compensation for any special damages including litigation costs and reasonable attorneys’ fees.”
In the case of the recent settlement with Boston Heart Diagnostics of Framingham, the whistleblowers who led to the uncovering of the illicit activity will receive approximately $4.36 million of that settlement money. Under the False Claims Act, successful whistleblowers are entitled to receive between 15 and 30 percent of the total money recovered. Continue reading