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Bothwell Law Group 304 Macy Dr, Roswell, GA 30076

Over $1.1 Billion
In Settlements
Since 2002

Mike Bothwell medical fraud whistleblower Atlanta

Medicare Fraud Whistleblower Attorney

Systemic Government Abuse & Medicare Fraud Hurts Everyone.  Report It And Help!

Systemic government abuse and Medicare fraud hurt everyone. Report it and help! The Bothwell Law Group has been working with whistleblowers to recover government money since 1996. We are Medicare fraud attorneys with an exceptional track record in settlements, whistleblower recovery percentage, and government involvement.

MEDICARE & HEALTHCARE FRAUD

Medicare fraud hurts the most vulnerable in our society and puts the future of these organizations at risk. Examples of possible fraud include upcoding; billing for unnecessary medical services; exchanging money, goods, or services for patient referrals (kickbacks); compensating employees or doctors based on referrals (Stark Law violations); referring patients to companies the referring provider has a connection to (corporate integrity agreements)

This list is not exhaustive, and fraudsters are constantly coming up with new methods. If you feel that something is not quite right but are not sure what, please reach out to us. We represent clients at the federal and state level and provide the legal expertise and experience our clients deserve.

WHISTLEBLOWER PROTECTIONS

The False Claims Act (FCA) provides protection to those who have been retaliated against for relaying concerns (to others in the company or to outside individuals) about possible fraud or for just trying to get the company to follow the law. This is true even if voicing concerns was only part of the reason the person faced retaliation. Retaliation has many different faces. It could mean you were fired, denied a promotion, or that your work environment became hostile. Whistleblowers who have been retaliated against are entitled to two times back pay and other damages.

Learn More About Whistleblower Protections

QUI TAM LAW

Qui tam is short for a Latin phrase meaning “[he] who sues in this matter for the king as well as for himself.” Qui tam laws allow a private citizen (called a relator) to sue on behalf of the Government. If the relator wins or settles, a certain percentage of the money (up to 30%) will go to the relator as a reward. Qui tam laws are nearly as ancient as the legal system itself, with early examples being found as far back as Ancient Rome. They reflect the unfortunate reality that the government does not have the resources to pursue all wrongdoing.

Learn More About Qui Tam

FALSE CLAIMS ACT

The False Claims Act, or FCA, was signed into law by President Abraham Lincoln following the Civil War to address rampant abuse of government funds by contractors. The FCA is a qui tam law, meaning it allows private individuals, called relators, to sue on behalf of the federal government for health care fraud and other types of false claims.

If the relator wins or settles, they are entitled to a percentage of the damages (up to 30%), with the rest going to the government to recoup the money stolen. While many FCA cases are Medicare fraud cases, it can be used against any person or company that misuses government funds, including pharmaceutical manufacturers and medical device manufacturers. The FCA can even apply to those who cause others to misuse government funds, for example, a subcontractor who fraudulently bills a contractor for work on a government project.

Learn More About The False Claims Act

Medicare & Government Fraud Whistleblower attorney in Atlanta GA

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The key to our success is that we embrace collaboration and demand that our strategists, designers and project managers work closely and directly with our

Medical Fraud

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TECHNOLOGIES

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Qui Tam

Learn more about Qui Tam law.

Whistleblower Protection

We represent whistleblowers and answer questions regarding whistleblower protections here.

Why Should You Hire A Healthcare Fraud Attorney?

$100 Billion Each Year

Department of Justice states that more than $100 billion may be lost in fraud, waste, and abuse annually. Health care fraud also undermines both the cost and quality of health care provided to patients. This underscores the critical need for skilled healthcare fraud attorneys to combat false claims and protect the integrity of healthcare benefit programs.

Not Limited To Care Providers

As anyone in the healthcare industry can commit fraud, including health care providers, pharmaceutical manufacturers, and medical device manufacturers, it’s crucial to have experienced legal representation. Healthcare fraud defense attorneys can navigate the complexities of federal laws and civil monetary penalties law to defend against false claims act violations and ensure justice is served.

Drug Fraud & Generic Substitutions

Healthcare fraud isn’t limited to billing practices. Drug fraud can occur when pharmaceutical companies encourage healthcare providers to prescribe medications for uses not approved by the FDA (off-label marketing). This can put patients at risk. Additionally, some pharmacies engage in deceptive billing practices by substituting generic drugs for brand-name medications but billing for the more expensive brand. A healthcare fraud attorney can advise you on your rights and potential legal action if you suspect such practices.

Anti-Kickback Statute (AKS) violations

The Anti-Kickback Statute (AKS) safeguards against a specific type of healthcare fraud. AKS violations occur when a medical facility steers patients towards certain providers in exchange for illegal kickbacks. Kickbacks can come in many forms, including cash payments, free office space, or excessive consulting fees. This practice creates an unfair incentive system, potentially influencing referrals based on financial gain rather than a patient’s best medical needs. Healthcare fraud attorneys can help whistleblowers expose AKS violations and ensure patients receive unbiased care.

Billing for medically unnecessary services

The healthcare industry is vulnerable to various forms of fraud, including false claims, false pretenses, and fraudulent statements. It’s imperative to have knowledgeable healthcare fraud attorneys who understand federal laws and civil monetary penalties law to mount an effective defense against allegations of healthcare fraud. Whether facing criminal charges or civil penalties, healthcare fraud defense attorneys can provide strategic legal counsel and representation to protect your rights and reputation.

Upcoding The Government

Upcoding is a deceptive billing practice where a healthcare provider submits false claims to Medicare or other insurers for more expensive procedures than those actually performed. This can involve surgeons billing for complex surgeries after performing simpler ones, dentists inflating the number of teeth extracted, hospitals submitting inaccurate diagnoses for higher reimbursement rates, or ambulance companies classifying routine transports as emergencies. Healthcare fraud attorneys can help whistleblowers expose upcoding schemes and recover funds stolen from taxpayers.

FAMILY MEMBER LEGAL REPRESENTATION

If a family member is implicated in healthcare fraud allegations, it’s essential to seek immediate legal representation from experienced fraud defense attorneys. The attorney’s office can provide guidance and support throughout the legal process, helping to navigate complex healthcare regulations and mounting a robust defense against false claims act violations or other criminal charges.

PATIENT RECORDS LEGAL DEFENSE

Patient records are often central to healthcare fraud investigations, and defending against allegations of false claims or fraudulent billing requires meticulous legal defense. Healthcare fraud attorneys with expertise in handling patient records can challenge false allegations, protect client confidentiality, and ensure that their clients’ rights are upheld throughout the legal process.

HEALTH AND HUMAN SERVICES LEGAL DEFENSE

Health and Human Services (HHS) plays a pivotal role in investigating and prosecuting healthcare fraud cases. When facing allegations of false claims act violations or other fraudulent activities, it’s essential to have experienced healthcare fraud attorneys who can effectively navigate interactions with HHS and other government agencies. From responding to subpoenas to negotiating settlements, healthcare fraud defense attorneys provide critical support and advocacy to protect their clients’ legal interests.

Healthcare fraud is rampant in this country and one of the primary bases for False Claims Act cases.

Healthcare fraud is a persistent threat, costing the government billions of dollars annually. The False Claims Act (FCA) serves as a powerful tool to combat this widespread issue. Whistleblowers can file FCA lawsuits against those who defraud various federal health programs, including Medicare, Medicaid, TriCare, Department of Veterans Affairs health insurance, Federal Employee Health Benefits (FEHB), Railroad Medicare, and even health insurance offered through the Affordable Care Act (ACA) exchanges.

New and creative methods of fraud emerge constantly, making vigilance essential. Healthcare fraud attorneys with expertise in FCA litigation stay up-to-date on the latest trends and can help whistleblowers expose these schemes and recover stolen funds.

Taking On Fraudulent Medicare

Our Track Record
Pursuing Justice For
Medical Fraud Cases

The Bothwell Law Group has a long and successful history of representing whistleblowers in Medicare and healthcare fraud cases. Our focus on whistleblower litigation allows our attorneys to develop deep expertise in the relevant laws and legal precedents.

We were pioneers in establishing the applicability of the False Claims Act (FCA) to Medicare fraud cases, and we continue to stay at the forefront of this complex legal arena. This experience translates into a proven track record of protecting our clients and helping them recover significant rewards for exposing wrongdoing.

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The Bothwell Law Group devotes its practice and resources exclusively to this incredibly complex and compelling area Medicare fraud cases

In past decades, good people faced a tough choice: Endanger their livelihoods and job standing by “blowing the whistle” or allow wrongdoing to continue.

Today, that’s no longer the case. The False Claims Act now protects whistleblowers who expose misuse of government funds, safeguarding their jobs and offering financial rewards. A qui tam statute, enhanced in 1986, specifies that ordinary citizens can now bring cases forward themselves. In filing on the Government’s behalf, you can position yourself to receive a hefty portion of any funds recovered through successful litigation.

Medical fraudulent behavior can violate the federal Stark Law, Anti-Kickback Statute and False Claims Act, as it affected claims made to Medicare, Medicaid, and TRICARE programs.

It is illegal to provide, pay, solicit, or accept money in exchange for patient referrals that are eligible for Medicare and Medicaid under the Anti-Kickback Statute. The Stark Law prohibits hospitals and medical practices from billing Medicare for services referred to entities with which they have a direct or indirect financial relationship.

Here Are Some Common Examples Of Healthcare Fraud Cases We've Represented:
  • Up-coding medical billing
  • Double Billing
  • Billing for non-existent or substandard medical equipment
  • Ordering and billing for unneeded services/treatment
  • Billing for services never rendered
  • Deceptive billings
  • Medicare/Medicaid fraud
  • Fraudulently retaining over payments
  • Enrolling non-existent or ineligible patients
  • Falsifying documents
  • Recruiting patients for services
  • Medicare Advantage and Part C fraud

You Have Whistleblower Protections Under The Law

Medical fraud whistleblowers are protected at the state and federal levels by the Georgia Whistleblower Act, the Occupational Safety & Health Act, and the Sarbanes-Oxley Act. According to Georgia law, whistleblowers are usually only protected when they reveal fraud against employers who are either the state or municipal government, discrimination against people with disabilities, or discrimination based on gender. Many people are left unprotected by this regulation when it comes to reporting medical actors who are acting immorally or illegally. Unfortunately, this leads to a lot of people being silent because they worry about reprisals. It is imperative that you consult with a knowledgeable lawyer who can clarify your legal rights.

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Your Information Is Privileged & Confidential

As always, your consultation is confidential and privileged, but please be aware that no attorney-client relationship is yet formed by this exchange of information. In other words, we will provide you with a free evaluation of your claim, but we do not represent you yet, even if you send in the information and receive a free consultation.

Should we feel that we can successfully prosecute a claim on your behalf, we will provide you with a written engagement letter outlining the terms of the representation. Regardless of representation, all your information is confidential, protected by the attorney-client privilege, and cannot be used in any way without your permission (and only for your benefit). Contact a Medicare fraud whistleblower attorney today for more information.

FAQs

What does a Medicare fraud attorney do in a whistleblower case?

A Medicare fraud attorney’s job is to help you determine whether a Medicare violation occurred. If you are considering blowing the whistle, you may need help to prove that a violation occurred. The Medicare system is complex. Therefore, it is easy to feel that something is not quite right when a company is actually in full compliance with the law. Speak to a Medicare fraud attorney about the situation to find out whether an actual violation occurred. They can help you avoid a situation where you lose your job because of a mistaken fraud report. It’s important to know what whistleblower laws protect – and what they do not protect. Because of attorney-client confidentiality rules, you can almost always ask your own attorney for advice. That’s true even if you have a nondisclosure or confidentiality agreement with your employer.

Have you already made a report? Your employer will likely do everything they can to prove that no violation occurred. They will likely call on an experienced legal team who will work hard to find every possible defense and loophole. If they succeed, you may lose whistleblower protections. Working with your own experienced attorney can help. This way, you can ensure your claims are evaluated on their merits and not by your employer being able to outmaneuver you legally.

How can we evaluate a Medicare fraud claim?

Medicare fraud typically involves some sort of false statement by a company. They may over-bill for services rendered or bill for services they never rendered. They may also engage in price-fixing. Finally, they may follow other non-competitive practices while claiming to operate under fair and open practices that give patients the best rates possible under market conditions.

When a fraud allegation is made, they will typically produce the falsified records as proof that everything was done properly. The key to proving a fraud claim is understanding how to exploit weaknesses in these documents. Furthermore, success depends on knowing how to use the available legal procedures to secure additional evidence that undermines the validity of these documents. This can be a monumental task for a layperson, especially if you are simultaneously fighting for your livelihood. To schedule a consultation with an experienced Medicare fraud attorney, contact Bothwell Law Group today.

HAVE A QUESTION?
WE'RE HERE TO HELP.

Phone:

770-643-1606

Email:

info@whistleblowerlaw.com

Address:

Bothwell Law Group
304 Macy Dr
Roswell, GA 30076