Upcoding and unbundling in healthcare are two forms of improper medical coding. Both fall under the federal government’s definition of healthcare fraud when the government is paying for the care and can be pursued through the False Claims Act. With serious implications that can cause harm to patients, taxpayers, and the American healthcare system as …
Continue reading “Upcoding and Unbundling are Common Types of Healthcare Fraud”
On February 1, 2022, the U.S. Department of Justice (DOJ) reported its False Claims Act (FCA) statistics for fiscal year (FY) 2021. DOJ reported more than $5.6 billion was recovered through the FCA in FY 2021. This is the second largest amount recorded and the largest since 2014. Almost $2.8 billion of the total recovery …
For more than a decade Colorado has had the Colorado Medicaid False Claims Act, making it unlawful for persons to submit false claims to Colorado’s Medicaid programs. However, fraud against the state occurs in many other contexts besides Medicaid (e.g., infrastructure contracting, purchase of goods and services, grant awards). On January 21, 2022, the State …
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On October 21, 2021, Senator Chuck Grassley discussed the importance of the False Claims Act during the Executive Business Meeting of the Senate Judiciary Committee. During his discussion, Senator Grassley exposed the fraud lobby’s efforts to undermine bipartisan, common-sense amendments to the #FalseClaimsAct, the government’s primary tool to fight fraud. Under the FCA more than …
In 1865, it was whistleblowers who were critical in reporting fraud by those who provided the U.S. War Department with rusty rifles, boats that leaked, and hats that melted in the rain. Today, whistleblowers are now critical to protecting the United States in the digital space. No longer on the battlefield of the Civil War, …
Why do we honor whistleblowers today? We honor whistleblowers because we rely on them to expose corporate wrongdoing. Whether insider employees, consumers or patients – whistleblowers see illegal conduct and do something about it. We honor whistleblowers because they model integrity and courage. Whistleblowers take a stand knowing that blowing the whistle is risky business …
Continue reading “Reflection on National Whistleblower Day 2021”
A recent decision out the 6th Circuit reinforces that former employees are protected from retaliation under the False Claims Act – even when the retaliatory conduct happens after they are fired or leave the company. In the lawsuit, an employee alleged he was “marginalized” for insisting on compliance with the law during his employment and …
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Knowing the kinds of fraud the federal government is focused on fighting is an important warning to health care providers, contractors, grantees, and others doing business with the government. But this information is also a source of encouragement for those who blow the whistle when such business dealings turn into fraud. Acting Assistant Attorney General …
Newly confirmed Secretary of Treasury Janet Yellen told the Senate Finance Committee that she was committed to respecting and protecting whistleblowers as “an important asset to the integrity of the agency and tax system more generally.” Read her written response to a question about the role of whistleblowers and a recent downturn in IRS whistleblower …
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The Department of Justice’s 2020 data is here, and it paints another compelling picture of the value brought by whistleblowers who file cases under the False Claims Act (FCA). In 2020, claims filed by whistleblowers were responsible for about 75% of new cases filed and about 75% of government fraud proceeds. And rewards made to …
