Submit a False Claims Act Report
You May Be Entitled to a Substantial Monetary Reward for Helping to Stop Fraudulent Billing and False Claims in the Healthcare Industry, including Hospitals, Nursing Homes, Rehabilitation Centers, Medical Offices, Dental Offices, Medical Clinics, Physical Therapy Offices, and so on.
What is the False Claims Act?
The False Claims Act (also known as the FCA) is an important federal tool used to recover government funds and property wrongfully acquired by bad actors. This is often used to recover funds paid to medical providers through government funded insurance plans, such such as Medicare, Medicaid, and TRICARE – be advised that the False Claims Act doesn’t apply to insurance plans that are entirely private.
These types of laws, which exist at the federal level and in several states, including New York, offer incentives for whistleblowers like you to share in the government’s recovery, and your share can potentially be in the range of 15 to 30 percent of the recovery depending on your knowledge of the fraud and based on other factors. You can read about some of these factors below.
In the meantime, submit your report to tell us a little bit about your story, it’s confidential. If you prefer to speak on the phone with a lawyer, you are welcome to call 917-719-1102.
Some Factors and Tips
The False Claims Act offers incentives for whistleblowers with genuinely valuable information, and the law has applied certain restrictions to discourage opportunistic plaintiffs who have no significant information to contribute of their own. Whistleblowers are often insiders that have access to confidential information, such as those in the following positions: executives, administrators, coders and medical billers, doctors, nurses, and medical assistants.
Be careful about the public disclosure bar which prohibits a share in the recovery if the information supporting the allegation is accessible to the public. Remember to keep your knowledge and evidence of the suspected fraud secret to the extent possible to protect your share in the recovery, unless you are otherwise directed by your lawyer. Do not speak to the media or post anything to social media about your suspicions. It is always advisable to refrain from speaking with anyone about your suspicions besides legal counsel.
Like in most types of legal cases, there is a statute of limitations on filing such claims, so be sure to speak with a lawyer as soon as possible, as time is running on your possible whistleblower claim. Among other potential considerations, your ability to share in the recovery, and the proportion of that share, may also depend on whether others have filed similar whistleblower claims before you, the extent of your involvement and/or culpability in facilitating or creating the fraudulent scheme, and so on.
The law requires that your allegations be supported with particularity, adequate enough to indicate to the court that it can rely on your allegation that an actual false claim was presented to the government. The adequacy of particularized allegations are case and context specific. Whistleblower are generally expected to be able to:
- specify the statements or acts believed to be fraudulent,
- identify the person or people making the fraudulent statements or performing the fraudulent acts,
- state where and when the statements were made, and
- explain why the statements were fraudulent.
As such, it is important to speak with a lawyer as soon as possible to evaluate your knowledge of the alleged fraud and the viability of your potential case.
Health Care Industry
The False Claims Act is particularly important when applied to the health care industry, since whistleblowers not only recover money for federal health care programs, but whistleblowers can also help deter fraud that puts patients at risk and artificially increases health care costs. Remember that the False Claims Act only applies to government funded healthcare plans, such as Medicare, Medicaid, and TRICARE.
As reported by the Department of Justice, in a case filed by whistleblowers against a group of skilled nursing facilities:
It was alleged that the company knowingly submitted or caused the submission of false and fraudulent claims to Medicare for medically unreasonable and unnecessary levels of rehabilitation therapy for Medicare Part A residents. It was alleged that the company pressured therapists to increase the amount of therapy provided to patients to meet pre-planned targets for Medicare revenue. These targets were alleged to have been set without regard to patients’ individual therapy needs. The whistleblowers in that case will collectively receive $3,006,000 of the settlement proceeds.
This law office was not involved in this example case above, and prior results do not guarantee a similar outcome.