Taking a stand for whistleblower rights
Taking a stand for qui tam whistleblowers
Taking a stand against corporate fraud
Combating fraud against the government
Many False Claims Act lawsuits involve health care fraud and these kinds of claims have resulted in billions of dollars in recovery to the government. This type of fraud occurs when a company, agency, or health care provider bills for services it does not provide, markets drugs off-label, accepts illegal kickbacks, fails to provide adequate nursing home services or otherwise violates contracts with the government involving health care.
Conduct that may be the basis of a False Claims Act or Qui Tam claim includes:
- billing the government for services not actually provided
Example: A physical therapist bills for a session he never performed, a hospital bills for medical supplies it never ordered or received, or a doctor bills an extra hour for every patient he sees.
- paying kickbacks to health providers to get government business
Example: A company gives physicians income guarantees, office-rent subsidies, low-Interest/no- interest loans, loan forgiveness, or provides staff support in exchange for referrals by the physicians to their company.
- providing services to government-pay patients that are not medically necessary
Example: A doctor bills Medicare for X-rays and other tests that a patient does not need; patients are put into hospice care who do not qualify for those services.
- upcoding medical services to get higher payment rate
Example: Medicare will pay more for an X-ray if it is used to detect a tumor or disease than if it is used for a routine check-up. Dishonest health providers will sometimes upcode their routine X- rays to get more money from the government.
- unbundling or fragmenting medical services
Example: Medicare and Medicaid offer discount incentives for groups of procedures that are often performed together. To increase the reimbursement amounts, doctors and hospitals will unbundle the groups of procedures and bill for them individually.
- marketing drugs off-label to physicians with government-pay patients
Example: pharmaceutical company sales representatives market a drug that has not been approved for dementia to doctors who prescribe for VA and Medicare patients.
- paying kickbacks to physicians to prescribe particular drugs to government-pay patients
Example: doctors who heavily prescribe particular drugs are handsomely paid as “consultants” when they give speeches about those drugs.
- using false information to get payment for services
Example: stating that services were supervised by higher-level medical personnel than were actually used.
- charging the government for inflated costs
Example: a doctor charges Medicare for sample drugs provided by a pharmaceutical company that were given to patients
- charging the government for ineligible costs
Example: a hospital charges the government for services provided by personnel not
- falsifying data to increase government payments
Example: nursing home inflates number of patients who receive a more expensive type of care.
- misusing grant money
Example: service-provider bills government for time spent on non-government projects.
If you have been witness to these or any other activities that could be considered illegal under the False Claims Act, contact Halunen Law.