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Qui Tam/False Claims Act: Healthcare

Even though watching the news might give you the impression that whistleblowers are a new phenomenon, the False Claims Act (FCA) has been around since 1863. Its original purpose was to fight fraud and corruption during the Civil War; thus, it is sometimes called the "Lincoln Law," in reference to Abraham Lincoln, who was president at that time. The law imposes liability on people and companies that attempt to defraud government entities. It also allows "whistleblowers" not related to the government entity being defrauded to bring legal actions on behalf of the government. Such actions are known as qui tam lawsuits, and the FCA refers to the whistleblowers who file such legal actions as "relators." The FCA stipulates that relators are entitled to receive a portion of the damages awarded. While the portion of the damages allotted to the whistleblower varies from one case to another, they often receive between 15 and 25% of the damages. If you are aware of healthcare fraud happening at your workplace, contact Greg Brod, Santa Rosa car accident attorney.

Medicare and Medicaid Whistleblowers

Medicare and Medicaid are publicly funded health programs. The doctors and hospitals who provide the treatments paid for by Medicare and Medicaid are not employed directly by the government and must bill these government programs for the Medicare and Medicaid-eligible services they provide. Overbilling is a widespread problem in the healthcare industry in general, not only with Medicare and Medicaid. Unfortunately, it is easy for doctors to bill Medicare and Medicaid for unnecessary services and to inflate the cost of necessary services provided, without getting caught.

Most FCA relators in healthcare fraud cases are physicians or employees of hospitals or private medical offices. After they bring legal actions against their employers, it is usually impossible for them to continue in their jobs. Thus, the portion of the damages awarded to them effectively acts as compensation for lost income.

Since 2007, the Medicare Fraud Strike Force has worked to root out fraud against Medicare. By the end of 2014, it had brought about more than 900 lawsuits and recovered more than 6 billion dollars in misappropriated funds.

The Affordable Care Act and the FCA

The Patient Protection and Affordable Care Act (PPACA) of 2010, popularly known as "Obamacare," has been a subject of political debate in the years leading up to and following its passage. It contains several important provisions that relate to the FCA, although these are not among the aspects of the PPACA that have received the most media coverage. These are the changes that the PPACA made to the FCA.

  • Whistleblowers should talk about healthcare fraud with their attorneys, not with the media. As of 2010, courts can decide on a case by case basis whether to dismiss a case on the grounds that a whistleblower disclosed it publicly before the case was decided. Before the PPACA, it was much easier for defendants in healthcare fraud cases to discredit whistleblowers who had publicly discussed the alleged fraud.
  • According to the FCA, a credible whistleblower must be an "original source." The PPACA has expanded the definition of "original source" so that more people now qualify as original sources.
  • The FCA stipulates that healthcare providers who receive overpayments from Medicare and Medicaid must return overpayments, but before 2010, the law was vague about what constitutes an overpayment and about the timeframe within which doctors were required to return these overpayments. The PPACA indicates that the deadline for reporting and returning overpayments is within 60 days of the discovery of the overpayment.
  • The PPACA makes it clear that violations of the federal Anti-Kickback Statute (AKS) automatically constitute FCA violations. The AKS prohibits the giving or receiving of financial rewards in exchange for patient referrals.
Greg Brod Represents FCA Relators

Greg Brod is a Santa Rosa whistleblower and qui tam lawsuit attorney. In addition to personal injury cases, he takes on clients who file FCA violation cases on behalf of the government. Healthcare fraud cases are an important part of making our healthcare system more efficient and making sure that taxpayers' money goes to providing needed healthcare services instead of being diverted into the pockets of fraudsters. Contact Greg Brod in the San Francisco area if you have information about Medicare or Medicaid fraud taking place at your place of employment. Now more than ever, the law is on your side. Filing a qui tam lawsuit can protect you as well as make more money available for doctors and hospitals to be able to provide needed services to all.

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