While the public debate over the rising costs of health care continues to make headlines, the Justice Department believes that health care fraud is a costly problem. Fraud in the health care industry is hard to detect for the federal government without the help of employees who notice unlawful billing practices.
Whistleblowers Help Recover $2.5 Billion In Health Care Fraud Claims
Last year, the federal government recovered $2.5 billion due, in large part, to the help of health care industry whistleblowers who bring forth evidence against nursing homes, hospitals, drug companies, physicians and medical device companies and other entities that use schemes to unlawfully enhance their own bottom lines.
The $2.5 billion in recoveries in health care was higher than any other industry. In 2016 alone, whistleblowers received $519 million for their efforts in bringing fraud against the federal government to light. In addition to the federal statistics, the lawsuits recovered millions for state governments, according to the DOJ.
State and federal laws, including the False Claims Act, allow individuals to file a lawsuit to recover taxpayer money when someone has committed fraud against the government. The Justice Department may join the lawsuit, and the whistleblower is entitled to receive a portion of any settlement or verdict. Overall, the federal government recovered a total of $4.7 billion in False Claims Act cases in 2016.
Principal Deputy Assistant Attorney General Benjamin C. Mizer stated in a press release that, "In short, Americans across the country are healthier, enjoy a better quality of life, and are safer because of our continuing success in protecting taxpayer funds from misuse."
Who Can Raise A False Claims Act Complaint?
It is important to note that not all whistleblowers are high-level executives who have intimate knowledge of an entity's billing practices. Workers throughout the system can have knowledge of a variety of issues that may constitute Medicare or Medicaid fraud. Office workers, accountants, nursing assistants and many others may have knowledge of abuse. Five of the most common schemes include:
- Billing for medical services that were never provided
- Providing excessive care that is not medically necessary
- Unauthorized -- or "off-label" -- marketing practices for medical devices or drugs
- Upcoding schemes that increase Medicare reimbursement
- Unbundling schemes that seek payments for individual services that are normally grouped together
If you are aware of fraudulent health care billing practices, you deserve to understand your rights. The law prohibits employers from unlawfully retaliating against an employee for reporting fraud against the government. An experienced False Claims Act lawyer can provide you with guidance.