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What Is a Qui Tam Medicare Lawsuit?

Understand the importance of a qui tam Medicare lawsuit.

Qui Tam Medicare LawsuitDo you know what constitutes a qui tam Medicare lawsuit? Medicare is a government-funded healthcare plan. It provides eligible citizens with affordable healthcare options. The system relies on honest workers and a reliable healthcare system to make sure it operates smoothly. However, not all healthcare workers play by the rules. And, if they defraud Medicare, they should expect to get caught and pay the price.

The Role of Private Citizens in a Qui Tam Lawsuit

Qui tam comes from a longer Latin phrase meaning, “as the king as well as himself.” This type of lawsuit allows citizens to pursue legal action on behalf of the government. Today, the majority of these lawsuits fall under the False Claims Act. The government passed this legislation to encourage citizens to come forward with information.

The term relator applies to those citizens who bring forth a qui tam lawsuit or whistleblowers. In the world of Medicaid fraud, whistleblowers play an important role in exposing and stopping criminal activity.

Common Types of Medicare Fraud

Those receiving care from a hospital, nursing home, or hospice should pay close attention to what goes on around them. Many reported Medicare fraud cases directly affect patients. Doctors may “over-diagnose” a patient to get a kickback from Medicare. Some healthcare works will even change a patient’s prescription to another drug for unethical reasons.

Patients may notice inconsistencies with their healthcare provider, but few report them. Many of the whistleblowers are actually employees. Here are some of the most common types of Medicare fraud reported:

  • Overcharging for procedures or charging for procedures never administered
  • Partially filling medications but billing for the full dosage
  • Raising prices for Medicare patients
  • Ordering unnecessary tests
  • Changing diagnostic codes
  • Falsifying a patient’s records to justify more costly treatments

Medicare fraud is very dangerous. It can significantly affect the quality of life for patients. This is especially true if the doctor prescribes drugs or treatments that are not medically necessary. Too many patients, however, don’t recognize the warning signs of fraud. Patients trust their doctors and healthcare workers to provide them with honest service. Unfortunately, Medicare fraud is more common than people realize. Some estimates report Medicare fraud affecting between 8% and 10% of claims.

Protections Provided to Relators with the False Claims Act

Speaking up about wrongdoings is the right thing to do, but many people are afraid to come forward. Those committing Medicaid fraud don’t want to get caught. The legal ramifications for cheating the government are very harsh. Guilty parties may find themselves serving time or paying a hefty fine.

When someone blows the whistle on Medicaid fraud, they’re putting themselves at risk. Those running the scheme may try to silence them. However, the False Claims Act helps to protect whistleblowers from retaliation. It makes it illegal to threaten, harass, suspend, or fire a relator. It’s important to note that each state imposes its own statute of limitations.

Money Awarded to Whistleblowers with the False Claims Act

Whistleblowers can expect to receive something in return for their help. Under the False Claims Act, they receive a percentage of the money the government is able to recover. Most of these awards fall between 15-30 percent of the settlement.

Depending on the size of the case, this can be a large amount of money. The total amount is also dependent on whether the government intervened in the case. It’s not uncommon for a whistleblower to receive millions of dollars for their help in cracking a Medicare fraud scheme.

With the risk of retaliation so high, even with protections in place, the monetary award is the only reason some relators speak up. Thanks to whistleblowers, the Department of Justice was able to recover over $2.5 billion in 2018. Without private citizens reporting tips, the majority of fraud cases would still go unnoticed.

The Role of a Lawyer in a Qui Tam Lawsuit

If you have information about possible Medicare fraud, the government wants you to report it to the Office of the Inspector General. While you may want to let everyone know, it’s best to keep it to yourself. You never know who you may upset in the process, and for your safety, you should stay anonymous for as long as possible.

Before reporting your tip, however, be sure to consult with a lawyer who handles whistleblower lawsuits. Your lawyer will do everything possible to protect your identity and make sure you get your full settlement. Never try to represent yourself. Contact the skilled qui tam Medicare attorneys at Bothwell Law Group by calling 770.643.1606 today.

How Prevalent Is Private Education Fraud?

Are the people in charge of your education guilty of private education fraud?

Recent events have brought to light the subject of private education fraud. While the sole purpose of any school is to educate, private schools also want to make money. Those we trust to educate our children may be engaging in fraudulent activities. Schools try to cover up illegal schemes. But, when the truth comes out, it becomes apparent how common fraud is in the private sector.

Education fraud is a hot topic this year. Several well-known schools are currently under investigation for admission fraud including Yale University and Stanford University, along with six others. The Department of Education oversees admission fraud cases. While these cases are still on-going, it has made the public fully aware of how prevalent fraud is in the education system.

Money: The Leading Cause of Fraud

As the saying goes, the love of money is the root of all evil. This is true in the education system. Schools rely on financial support to provide students with the best education possible. Unfortunately, some schools cross the line.

Schools may also mishandle how they report and spend their money. Administrators may lie about how much money the school makes in a year by deducting expenses that don’t exist and hiding funds. This is usually done to avoid paying taxes or to be eligible for additional funding. No matter the reason, this is a form of fraud.

Defrauding the Department of Education

Schools can also defraud the federal government. The government provides loans to many students attending private schools. The money received from these loans goes to fund the school where the student attends. If the school obtains these loans through devious methods, they’re defrauding the government. Taxpayers end up paying the bill for this illegal behavior.

Here are some ways a school may illegally obtain funds from federal loans:

  • Providing false information – to meet the conditions of a federal loan, a school may lie about certain aspects of their organization.
  • Failing to return funds – if a student withdraws, the school may withhold this information to avoid repaying any federal funds.
  • Illegally recruiting students – the school may provide an illegal incentive to a headhunter who can recruit the most students.
  • Lying about graduation and job placement – schools must provide accurate reports regarding their graduation and job placement rates. Falsifying this information is illegal.
  • Covering up academic eligibility – the school may lie about a student’s academic history to continue receiving funding.
  • Filling out loan applications without consent – it’s illegal for a school to fill out a federal loan application without informing the student.

This type of fraud usually begins at the top, and it requires the knowledge of many individuals to work. It’s often surprising to see how many people willingly participate in education fraud once a case becomes known to the public.

The Impact of Private School Education Fraud

While many people seem to think that private school education fraud only affects those who attend a specific school, they are wrong. Since this money often comes from the federal government, it’s really the taxpayers who lose. Unfortunately, schools go to great lengths to cover up this type of fraud. For this reason, many school administrators get away with participating in illegal activities.

The Department of Education investigates any reports of fraudulent activity. But, to begin an investigation, they need to know where to look. In many instances, they receive a tip from a local whistleblower. The department maintains a hotline for tips. They also provide outreach to help others understand how to identify education fraud. Anyone who has information about school fraud should consider informing the proper authorities.

What to Do if You Know About Fraud in Schools

It’s impossible to prosecute educational facilities if no one speaks out. Those involved keep their lips sealed. That’s why the Department of Education relies so heavily on the testimony of whistleblowers. It takes a lot of courage to come forward, but it’s always the right thing to do. When the case settles, you may also receive compensation for your efforts. Most whistleblowers can expect to receive 15-30 percent of the recovered money.

Before you tell your secret, find a lawyer who handles these types of cases. Retaliation is real, and you need to know your rights as a whistleblower. You need someone who knows how to keep you protected during the process. Find out more about private education fraud by contacting Bothwell Law Group online.

What to Do if You’re Aware of Fraudulent Defense Contractor Claims

Here’s what to expect if you become a whistleblower for fraudulent defense contractor claims.

Fraudulent Defense Contractor ClaimsEven with the government keeping a close eye on things, there is never a shortage of fraudulent defense contractor claims. While most contractors perform a task honestly and to the best of their ability, some cheat the system. You may find out this information before the government does. If you find yourself in this situation, you may want to report the fraudulent activity. Before you do, make sure you know what to expect once you blow the whistle.

Type of Fraudulent Defense Contractor Claims

The government hires numerous contractors to perform specific duties. Some contracts go to large corporations, like Boeing and Lockheed. The government also contracts smaller businesses for certain tasks, including janitorial services. Contractors supply the country with the tools it needs to operate. This includes everything from airplanes and missiles to office furniture. Reports show that the United States government spends about $500 billion per year on contracts.

While the government thoroughly vets every contractor, it can’t completely stop fraud. Both large and small contractors may commit fraudulent acts, costing taxpayers a hefty sum. Some examples of defense contractor fraud include:

  • Over-billing or cross charging
  • Providing services or products that do not meet agreed upon standards
  • Failure to inform of product defects
  • Product substitution without consent

A government contractor is legally obligated to provide and charge only for the services stated in the contract. Steering away from these terms is illegal and a form of fraud.

How to Report Fraudulent Contractor Activity

If you become aware of contractor fraud, you may feel inclined to report it. After all, taxpayers must fund excess government excess spending. Before you spill the beans, however, you must consider several things.

Fraudulent activity often involves many people or entities. You never know if the person you once trusted is part of the scheme or not. While you may want to inform your boss or coworker of your findings, this may not be wise. Whistleblowers often deal with retaliation after coming forward. It’s best to trust no one until the investigation is complete.

The Department of Defense has a hotline for citizens to report fraud. They will evaluate your claim and look into the matter. But just because you report something doesn’t mean it will get resolved. Investigations often take years to complete. You may find yourself dealing with legal issues for a long time.

Protections Provided to Whistleblowers

You may feel afraid to come forward after learning of fraudulent behavior. While it’s true that being a whistleblower isn’t easy, it’s necessary. Authorities have been able to solve many defense contractor cases because of a whistleblower. Yes, it’s not an easy job. But, knowing you’re helping the government and citizens often makes it worth the risk.

Because the government wants you to come forward with information, it protects whistleblowers. The False Claims Act allows private citizens to sue federal contractors on behalf of the government.

The False Claims Act also protects whistleblowers. It makes it illegal for affected parties to seek retaliation against the relator. This includes harassing, demoting, firing, or threatening the whistleblower. If someone violates the False Claims Act, the victim has the right to take legal action.

The Benefits of Reporting DOJ Contractor Fraud

Being a whistleblower also comes with some benefits. First and foremost, you may help prevent injury or loss of life. Yes, it’s that serious. If a contractor sells the DOJ faulty equipment, it may end up harming the troops. If a product makes it to the general public, civilian casualties may occur as a result.

The government also offers monetary compensation to whistleblowers. If your information leads to a conviction, you will receive a percentage of the settlement. This may equal millions of dollars depending on the complexity of the case.

Never Report Defense Contractor Fraud Alone

Before you decide to come forward with any information, you need to retain a lawyer who has experience with defense contractor fraud. These cases can get very complicated. As soon as the information becomes public, you will become a target. Consider hiring a lawyer before you make your initial report.

A lawyer will make sure you’re aware of your rights as a whistleblower. If you become the victim of retaliation, a lawyer will help you seek recourse. While you may want to speak with journalists or media outlets, you shouldn’t contact anyone before speaking with an attorney. Others may want to take advantage of you, but an attorney will help you make wise decisions.

If you have information about possible DOJ contractor fraud, don’t try to navigate the system alone. You may find yourself in over your head if you don’t have legal representation. Find out more about fraudulent defense contractor claims by contacting Bothwell Law Group online.

Whistleblower in a Medicaid Fraud Case? Here’s What You Need to Know

Don’t blow the whistle until you know what to expect when you become a whistleblower in a Medicaid fraud case.

Whistleblower in a Medicaid Fraud CaseKnowing without a doubt that someone is doing wrong is enough reason to become a whistleblower in a Medicaid fraud case, right? In a perfect world, you would come forward with the information, and the guilty party gets sentenced. You become a hero, and everyone sings your praises. However, this is not always the case.

We do not live in a perfect, honest society. Medicaid fraud is rampant. The National Conference of State Legislatures reports that this type of fraud costs states billions of dollars per year. If you know something, the government wants you to speak up. But, becoming a whistleblower is not as simple as it may sound.

Here are the top things you should know before choosing to become a whistleblower:

Your Word Isn’t Always Enough Proof

Even if you know without a shadow of a doubt that someone is committing fraud, your word isn’t proof enough. To investigate further, authorities need more evidence. Sure, if you call and make a formal complaint, they will look deeper into the matter. That doesn’t mean, however, that they will ever collect enough evidence to make an arrest.

What makes it so difficult to gather evidence? The Fourth Amendment puts limits on how authorities can search and collect evidence. It protects citizens from unwarranted searches and seizures. To legally search a suspect’s property, the authorities must have probable cause. They must also obtain a warrant. Even if you know that someone is guilty, your word may not provide enough probable cause to further the investigation.

However, this doesn’t mean you shouldn’t make a complaint or report someone. If the fraud is blatant, your word may be all it takes to initiate the case. Authorities may have enough information from your testimony to open a case and convict the perpetrators.

You May Face Retaliation

Coming forward with information is the right thing to do, but it’s not always safe. Unfortunately, many whistleblowers become targets for retaliation. In many cases, these cases involve a network of individuals. It’s rare for only a single person to run a scam of this nature. If you stop their money-making venture, you may find yourself a victim of retaliation.

There are many different levels of retaliation. Some people may see you as a traitor and treat you differently at work or in private. It’s not uncommon for the accused party to fire, demote, suspend, or monetarily punish a whistleblower. A whistleblower may experience public shaming or harmful threats. Retaliation is illegal, but the law is not always correctly understood or enforced.

While the federal government offers protections to whistleblowers in many cases, these laws vary from state to state. Some states only protect whistleblowers in the public sector and not those who work for a private employer. A lawyer can help explain the different whistleblower laws for your area.

You May Receive a Large Cash Payout

The law allows whistleblowers to collect a considerable cash sum after settlement. This amount may vary, but it usually falls somewhere between 15-30 percent of the settlement figure. The percentage varies on the type and location of the case. For most whistleblowers, the possibility of receiving a cash payout is very enticing. And in many cases, it’s the only reason someone chooses to come forward.

However, be aware that the final settlement amount determines the amount you will receive. Many cases settle for much less than the initial complaint. You may not receive the compensation amount you initially expected. Weighing the pros and cons of a cash payout is important. For example, will you lose your job as a result of becoming a whistleblower? How long will the case last? You may find yourself waiting several years before the case finally closes.

You Need Legal Counsel

Whistleblowers have helped solve many Medicaid fraud cases. Authorities rely on others to provide information to help convict guilty parties. If you have information that could crack open a fraud case, you should consider alerting the proper authorities. But, before you do, it’s best to hire an attorney to represent you.

As a whistleblower in a Medicaid fraud case, you may find yourself in a stressful or dangerous situation. Others will try to stop you from talking. You may feel unsure of how to proceed. You need someone who knows the law and how to protect you. An attorney will guide you through the legal process. This will help you maintain your safety, privacy, and integrity throughout the entire case.

The legal team at Bothwell Law Group represents clients who are a whistleblower in a Medicaid fraud case. Whistleblowers run into resistance at every turn. A whistleblower lawyer will help you navigate these turbulent waters with ease. Contact the skilled Medicaid fraud whistleblower attorneys at Bothwell Law Group by calling 770.643.1606 today.

Can You Rely on Federal Whistleblower Protection?

Many laws provide federal whistleblower protection for people who report illegal activity.

Federal Whistleblower ProtectionWhistleblowers assume a lot of risk by coming forward. Lives can change overnight. While attempting to right something legally wrong, the whistleblower faces the possibility of retaliation by those who would prefer that things stay the way they are. That’s where the concept of federal whistleblower protection comes into the picture.

Are there federal protections for whistleblowers? What kinds of protections exist? If someone takes action against a whistleblower, what are the repercussions? Here are some answers to those questions.

Whistleblowers and the False Claims Act

The False Claim Act (FCA) is one that impacts whistleblowing and provides some degree of protection for those who come forward. It can be tempting to focus on potential compensation for revealing and cooperating in investigations related to illegal activity, there’s another side to consider.

The FCA imposes penalties and possibly jail time for those who seek to interfere with an investigation into fraud. Attempting to compromise a whistleblower with the use of intimidation or other means could be interference. In this scenario, the authorities would bring charges against the party attempting the intimidation. The result is protecting the investigation’s integrity while also protecting the whistleblower from threats.

The Provisions Found in OSHA’s Whistleblower Protection Program

One of the more comprehensive examples of whistleblower protection on a federal level lies within the Occupational Safety and Health Administration’s Whistleblower protection programs. Some examples of the program provisions include:

  • Preventing an employer from firing an employee who has filed a complaint. The clauses within the programs relate to the original complaint as well as any complaints about threats related to the continued employment.
  • Transferring the employee to a position with less pay or otherwise taking actions to reduce the employee’s benefits. Sometimes used as a strategy to get the employee to resign, the protections from this type of activity help to ensure the whistleblower can continue to earn an equitable living.
  • In the case of hourly employees, reducing the number of assigned hours per pay period. Again, this provision helps to ensure the whistleblower does not find oneself in a difficult financial position because of coming forward.

All told, there are more than 22 different laws related to various industries that protect whistleblowers. From employees in mining operations to health care facilities to manufacturing plants, one or more of those laws are likely to apply.

Timely filing of complaints is essential with each of those laws. Within the terms and conditions found in each law, there is a specific number of days in which to file. Some laws or acts allow only 30 days to file a complaint. Others allow as long as 180 days. An attorney who is familiar with the laws that apply can advise the client of the number of days left before a filing becomes impossible.

The Protection Applies to Private as Well as Public Company Employees

In times past, there was some difference of opinion about whether whistleblowing protections applied only to employees of public companies. The US Supreme Court settled the question in 2014 in the case of Lawson v. FMR LLC. The ruling was that current whistleblowing laws apply to employees working for private contractors and subcontractors of public companies as well as personnel in the employ of those public companies.

Protections for Employees of Governmental Agencies

Whistleblower protections are not limited to people who work for companies or non-profit organizations. They also extend to government employees. The Whistleblower Protection Act of 1989 includes these protections.

As with laws protecting other types of employees, the WPA prevents a whistleblower from demotion or termination because of the decision to report the alleged illegal activity. It is not legal to reduce the pay of that employee for the duration of the investigation or any subsequent legal action taken. The employer cannot replace the employee during this period. Illness is the only exception. Even then, the employee may resume his or her position after the illness passes.

The Relationship between Federal and State Whistleblowing Laws

Some states have passed laws related to whistleblowing and protections extended to whistleblowers. New York is a good example. When there are state laws that apply to a given situation, those laws must be in harmony with federal laws. Whistleblower attorneys are aware of any state laws that exist. They also know how those state laws relate to federal laws, and which ones do have some bearing on the rights of the whistleblower.

Do you have evidence of fraud or illegal activity within an organization? Contact the skilled federal whistleblower protection attorneys at the Bothwell Law Group by calling 770.643.1606 today.

Understanding the Role of the Pharmaceutical Whistleblower

Whether within the company or outside the organization, the pharmaceutical whistleblower is a powerful legal resource.

pharmaceutical whistleblowerWhistleblowing is a term that describes people who become aware of activities within an organization or entity that are legally questionable. They don’t pretend they know nothing. Instead, the whistleblower chooses to reveal the activity. As in any industry, the actions of a pharmaceutical whistleblower have the potential to trigger changes for the better. Here are some basics that you should understand about whistleblowing and the possible outcomes.

Two Kinds of Whistleblowers

There are generally two distinct types of whistleblowing. Understanding how the two are similar and how they are different is important. It’s easier to see how the role of a whistleblower within the pharmaceutical industry aids in stopping the abuse.

  • Internal whistleblower: The whistleblower has a connection to the organization. This could be an employee, an officer, or a shareholder. The internal whistleblower shares the information with one or more people within the organization. Those people would be figures with authority to take action.
  • External whistleblower: External whistleblowers reveal the activity to someone outside the company. That entity may be a law enforcement agency that has jurisdiction. It could also be a governmental agency that has oversight of the organization in some manner. Furthermore, the whistleblower may choose to take the information straight to the media.

How does the whistleblower determine which approach to use? Is there a reason to believe someone within the company will handle the matter? Then the whistleblower won’t see any need to contact outside parties. There’s trust that everything they are in compliance with current laws. However, when there is little confidence that internal personnel will handle the situation, contacting an outside entity makes sense.

A Pharmaceutical Whistleblower Example

Whistleblowing is nothing new. In fact, we see more and more cases of whistleblowing each year. Within the pharmaceutical industry, whistleblowing often has to do with the development and release of new products.

Consider this example. An employee is working on a new product due for release in six months. He or she becomes aware that the company knows the product triggers a set of side effects. The company withheld that information from governmental agencies as well as from the public or the medical community. Given the circumstances, the whistleblower reports the side effects to a legal entity. He or she may even want to take the information to the public through the media.

Taking this type of action does involve risk on the part of the whistleblower. Attempts to discredit the individual are likely to take place. Furthermore, loss of employment or other issues may also arise. Hence, most people who chose to become a pharmaceutical whistleblower only do so after considering their options carefully.

Whistleblowers and the False Claims Act

The False Claims Act provides some amount of protection for whistleblowers. Employing the concept of qui tam, the whistleblower or relator has the right to some amount of compensation. This is in exchange for cooperating with an investigation into the claims. Finally, if the claims prove to be valid and the lawyers decide to take legal action, the level of compensation can be significant.

Whistleblowers and the Need for Legal Counsel

Seeking legal counsel before choosing to pass on information to anyone, either within or outside the company, is a smart move. An attorney can listen to what the client has to say and ask questions related to the evidence. Furthermore, the attorney helps the client understand what sort of outcomes are likely depending upon the actions they take. That includes what could happen if the client chooses to bypass internal personnel and go straight to the media or a government entity.

The attorney will also seek to protect the employee’s rights to the full extent of current laws. That includes preventing the client from losing his or her job. The attorney manages any communications between the alleged perpetrator. Also, they provide advice related to the client’s personal conduct while the investigation progresses. If the matter does result in a lawsuit, the attorney will usually continue to represent the client.

Whistleblowers sometimes feel that legal counsel isn’t necessary. However, help from an attorney is a good idea. Having legal guidance reduces the risk of retaliation. Also, it ensures proper procedures are followed. That’s important when it comes to approaching a government entity or making a case in court.

Do you have information about illegal activity within a pharmaceutical organization? There’s no reason to navigate your situation alone. You can have the help of an experienced legal team. Click to find out more about the rights and legal protections offered to a pharmaceutical whistleblower by contacting the Bothwell Law Group online.

Setting Expectations When It Comes to False Claims Settlements

What can you expect with false claims settlements? Here are some points to ponder.

false claims settlementsThere are provisions found in the False Claims Act that make it possible to file suit and seek false claims settlements. If you’re considering blowing the whistle for false claims you are aware of it’s important that your expectations are realistic.

Experienced attorneys strive to set reasonable expectations with their clients and help them understand what could come to pass. Here is some basic information you should know about why defendants would be willing to settle and what could happen if there is a settlement.

Reasons Providers Settle Instead of Fighting Suits

Physicians, hospitals, hospice centers, and nursing homes may choose to settle a false claim lawsuit for many reasons. Some of the most common are:

  • Minimize legal fees: The legal costs related to fighting the claim may be prohibitive. If the case continues for a long time, those fees could be more than the amount of the original suit. When that is a real possibility, settling now translates into lower legal fees.
  • Reduce the amount paid to Medicare and/or the plaintiff: Defending against a lawsuit and ultimately losing does mean the risk of paying a higher figure to the plaintiff or repaying a more substantial sum to Medicare. In many cases, it would be both. When the parties who filed the suit are willing, negotiating a settlement could result in paying a much smaller amount.
  • Avoid negative publicity: Reputation is essential in the health care field. If word gets around that someone has intentionally falsified claims it could take years to undo the damage. Quickly and quietly settling contains the potential damage and makes a public relations disaster less likely.
  • No admission of guilt: The terms of many settlements exclude any requirement for the provider to admit guilt. That’s important, as it minimizes the risks of losing the license to practice or to operate a facility.
  • A matter of time: A settlement may be the best solution just because of the time involved. Next to the financial resources needed to fight the suit, allocating time for this action means less time to generate revenue or keep the facility or practice going.

Whatever the reason is for settling, the decision to settle impacts the plaintiff. The degree of that impact depends on what happens next.

Terms and Provisions within False Claim Settlements

Every settlement associated with a false claims lawsuit will include specific provisions. Those terms relate to the plaintiff as well as the defendant. Depending on the nature of the claim and the original amount sought, the terms and provisions may or may not include specific actions that one or both parties agree to observe.

The terms of payment are one example. In some cases, the plaintiff agrees to pay the settlement amount by a specific date. They can pay the sum in a series of installments leading up to the due date or pay the entire amount at one time. Depending on the number of plaintiffs, a trustworthy third party receives the payments and disburses the funds based on an approved schedule.

The plaintiff may agree to refrain from taking any further legal action against the defendant. The wording on this provision must be exact. A broad provision could prevent the plaintiff from pursuing action related to the same plaintiff but for a different cause. That includes claims prosecuted under laws other than the False Claims Act.

Sealing the terms of the settlement is another common approach. With this particular provision, the plaintiff and the defendant agree to not reveal the details of the settlement or talk about the case in anything other than the broadest terms. The goal is often to protect the privacy of all parties involved in the original suit.

The Bottom Line:  What about the Compensation?

What can you expect in the way of compensation? The plaintiff may agree to pay all legal fees, including the funds owed to your legal counsel. That’s good news since the plaintiff has no legal fees to pay.

In terms of how much the plaintiff may receive, a lot depends on whether a federal agency is among the relators and the degree of agency involvement. When the suit does not include a government entity, the relator who launched the lawsuit is by law allowed to receive somewhere between 15% and 25% of the settled amount. The remainder goes to Medicare.

Whistleblowers who pursue a case after the government chooses not to act may receive somewhere between 25% and 30% of the settlement amount. A writ of qui tam makes this possible. The private citizen comes forth with information and assists in pursuing a case of false Medicare claims issued by a health care provider.

Do you have some involvement with a claim you believe to be false? Contact the Bothwell Law Group online and get more information about false claims settlements and what to expect.

How Common Are False Claims by Medicare Providers?  

False claims by Medicare providers are more common and varied than most people think.

false claims by medicare providersCan you imagine the impact false claims by Medicare providers could have? Medicare is often the difference between a patient being able to receive health care and having to do without. In spite of the good it does for so many, there are those who attempt to game the system. That includes false claims by Medicare providers. How prevalent are these claims? It happens more often than most people realize.

Facts and Figures for Recent Years

Since the advent of the 1863 Federal False Claims Act, whistleblowers have come forth to stop specific incidents of fraud. While the majority of fraud once included fraudulent claims by suppliers and contractors, falsified Medicare claims increased significantly by the 1990s.

According to figures prepared by the US Department of Justice and released through the Department of Public Affairs, lawsuits filed between 1986 and 2018 recovered more than $59 billion. Much of that figure had to do with claims made by providers reported by whistleblowers and subsequently triggered lawsuits.  

During 2018 alone, 767 lawsuits related to provisions in the FCA began moving through the court system. Of that number, whistleblowers initiated 645 lawsuits. This continues the pattern that emerged over the last decade of new FCA cases having to do with alleged cases of false Medicare claims.

How Do They Do It?

There’s more than one way to go about falsifying Medicare claims. Providers who engage in this type of activity are likely to try one or more of the following:

  • Billing for services never performed: This may involve patients who often seek medical care and would not notice receiving one more claim report.
  • Billing for services that were unnecessary: Padding the claim with procedures or services the patient does not need is likely to draw even less attention from the patient.
  • Upcoding: Instead of billing for services rendered, the provider bills for similar services that are more costly and not merited given the patient’s current state of health.
  • Prescribing medications that the patient doesn’t need: The motivation here could be a kickback from a manufacturer in exchange for increasing the demand for a particular drug or classes of drugs.

These are only some of the more common approaches to creating false Medicare claims. Depending on the amount of effort put into creating documentation to back up the claim data, the fraud may be hard to detect even during a medical audit.

Signs Indicating an Altered or Completely False Claim

The fact that a false claim can be difficult to spot does not mean it’s impossible. A few signs could indicate all is not on the level. Knowing those signs makes it easier to determine if someone is the victim of a provider.

You may find that provider statements and receipts don’t match the details on the claim reports issued by Medicare. For example, you receive a claim report for services rendered on a date when you were out of town. That’s a sign something is wrong.

Even if the dates are right, the treatment received is not the treatment listed on the claim report. This can be more difficult for patients to spot if they are not familiar with the name of the treatments. It’s often helpful to compare any statements received from the provider with the detail on the claim report.

Perhaps the date is correct and the description of the treatment matches. What is different is the expense filed with Medicare. It happens to be more than initially quoted.

Any of these scenarios could be honest mistakes. The changes could also be intentional. If you talk with the provider and get a feeling that there’s something other than a clerical error involved, it’s time to take action.

What Can You Do About False Claims by Medicare Providers?

Protect yourself by keeping a log of all your medically-related appointments. That includes trips to the pharmacy to fill prescriptions. This allows you to cross-reference dates, treatments, and even events like annual physicals.

If you believe the activity is not an isolated event and the provider makes no effort to correct the problem, consulting with an attorney is a smart move. The attorney can help you assemble the necessary data and prepare to take legal action, including contacting Medicare and providing information about what you believe is taking place.

Do you suspect that a Medicare claim is fraudulent? Call 770.643.1606 to speak with one of the skilled lawyers at Bothwell Law Group today. If there is evidence of false claims by a Medicare provider, we’ll use every legal means to get to the truth.

Who Is Responsible for Qui Tam Attorney Fees?

What do you need to know about paying the qui tam attorney fees? Find out here.

qui tam attorneys feesPeople who file a whistleblower lawsuit are often concerned about qui tam attorney fees. The common perception is that it will cost a lot of money out of your own pocket. This can make it seem like a qui tam lawsuit is a gamble, especially if you’re unsure of the case’s merits. However, the expenses in these cases usually come out of any recovery that you receive. This article explains how it works.

Contingency Fee

A whistleblower attorney usually performs an initial review of a case for free. Once the attorney decides to take the case, you can retain the attorney on a contingency basis. This arrangement means that you will pay the attorney only if the case is successful and you receive a reward from the government. An attorney who works on a contingency basis pays all expenses needed to represent you. These expenses include the costs of hiring expert witnesses, traveling, and completing documentation. They are also entitled to seek reimbursement of these expenses from the defendant if the case is successful.

The Whistleblower’s Reward

Your reward will be a percentage of what the government recovers in the event the suit is successful. This percentage can range from 15 to 30 percent of the total recovery, dependent on several factors. The most important of these is whether the government decides to pursue the case. Your percentage of the recovery will be less with government intervention.

Another factor that helps determine your reward is the value of the information you provide. Information with greater value will result in a higher reward. Your role in the case is also a factor the court will consider when assessing your percentage of the recovery.

The recovery in these cases can be up to three times the damages to the government plus the civil penalties. Each act of fraud can incur a separate penalty, which can be up to $11,000. Qui tam cases can include hundreds of separate acts, so the recovery amounts can be quite large.

Starting the Case

Initiating a qui tam case costs very little even if you don’t have an attorney yet. It does incur a filing fee and other minor administrative expenses. This means you can take a qui tam case some distance without spending any significant money up front, even without an attorney.

Government Intervention

You need to inform the government about the facts of your case once you file it. This allows the government to begin investigating your claims. The government will keep your case secret during this phase to prevent the defendant from hiding or destroying evidence. You should not discuss the case with anyone other than your lawyer and the government officials investigating the case.

The government may decide to take over the case at this point. In this case, you shouldn’t incur many expenses since your attorney won’t be prosecuting the case. Government intervention also means you have a strong case, so you’re more likely to receive a reward.

No Government Intervention

You still have the option of pursuing your case even if the government declines to prosecute it. You should not have to pay anything up to this point, including attorney fees or other expenses. This option has a greater risk because there may be costs involved from this point. However, you will also get a more significant share of the recovery if you win.

You will need to have a detailed discussion with your attorney at this point to determine if you will proceed without the government. In particular, you need to know if the attorney fees are likely to exceed the reward you receive. It’s also important to know when you would receive the reward, as qui tam cases can take years to decide. Another factor to consider is that you may become unemployable in your current profession if you become known as a whistleblower.

Recovering Expenses and Qui Tam Attorney Fees

Most qui tam cases fall under the False Claims Act (FCA), although the federal government has other qui tam laws. The FCA provides that whistleblowers may be eligible to recover legal costs from the defendant in addition to the reward itself. These expenses can include attorney fees and other costs associated with trying the case.

A whistleblower has the standing to recover these fees, not the whistleblower’s attorney. Furthermore, the whistleblower generally receives these fees directly, rather than the attorney. Reimbursement requires the whistleblower to have an attorney-client relationship with an attorney. This rule applies even in cases where the whistleblower is an attorney.

Understanding the fees related to whistleblower cases can be confusing. Get all of the information you need about qui tam attorney fees by contacting Bothwell Law Group today at 770.643.1606.

Tips from Pharmaceutical Whistleblower Lawyers on How to Report Fraud

What do you need to know if you’re a whistleblower in a pharmaceutical case? Get the details you need about pharmaceutical whistleblower lawyers.

pharmaceutical whistleblower lawyersPharmaceutical whistleblower lawyers work on cases involving drug fraud against the government. These cases fall under the qui tam provision of the False Claims Act (FCA). This law allows a person to sue companies on behalf of the government. The exact process depends on the specific type of drug fraud. The following categories cover the most common types of fraud:

  • Off label drug promotion
  • Kickbacks
  • Medicaid rebates
  • Adulterated drugs

Off Label Drug Promotion

Off label drug promotion is the most common type of drug fraud. It occurs when a company receives FDA approval to use a drug for one use but promotes it for another use. Assume for this example that the FDA approves drug XYZ for the treatment of diabetes. The drug company then contacts doctors to promote its benefits for treating depression. It may even say the drug has FDA approval without saying that it’s only approved for treating diabetes.

Your evidence needs to show the company intentionally promoted off label drug use for this case to qualify as fraud. The key requirement is specific evidence showing this intent. This evidence includes documents of training sessions that explain how to promote drugs for off label uses. Another example of strong evidence for drug fraud would be letters to doctors with marketing information on off label uses.

Recognizing Kickback Schemes

Kickbacks are the second most common form of drug fraud. This type of fraud occurs when a drug company pays a healthcare worker to promote their drugs. These workers may include doctors, nurses, hospitals, pharmacies, and nursing homes.

It’s generally illegal for drug companies to offer financial incentives to their customers. These activities are rarely as obvious as handing over a bag full of cash. For example, drug makers can provide healthcare workers with marketing materials. These materials could include inexpensive items such as pens and coffee mugs. Such items don’t constitute drug fraud by themselves. However, companies often cross the line by offering more costly items.

Another example is when a drug company hires a doctor to provide consulting services. It can be difficult to show that this case is a kickback since the doctor is providing a service.

Drug companies go to extreme lengths to hide kickback schemes. You could be eligible for a reward if you attended a discussion of these schemes. The minutes from such a meeting can be useful for showing kickbacks. This is especially true if the speakers at the meeting were executives. Inside information on how these schemes are taking place can also be strong evidence of kickbacks.

Medicaid Rebate Fraud

Medicaid rebate fraud involves drug companies underpaying Medicaid rebates to the government. Drug companies must belong to the Medicaid Rebate program to provide drugs for Medicaid patients. This program prohibits companies from charging Medicaid more than they charge other customers. Drug companies must submit a report to Medicaid every quarter showing the highest price they charged for each drug. They must then pay Medicaid a rebate if Medicaid paid a healthcare provider more than the company charged other customers for that drug.

The specific schemes for committing Medicaid rebate fraud are highly varied. You might be eligible for a reward if someone at a drug company lied about drug prices. You generally need to show that someone lied about a drug’s average manufacturer price (AMP) or average wholesale price (AWP). Drug companies use these figures to calculate the rebate they owe to Medicaid.

Adulterated Drugs

The use of adulterated drugs is a less common form of drug fraud. However, its frequency is increasing as process controls for drug manufacturing becomes stricter. The FDA must approve a drug’s manufacturing processes, including quality control procedures. A drug company may commit drug fraud when it materially deviates from its approved processes.

The key criterion for this type of fraud is whether these changes have the potential to affect the drug. Small errors aren’t enough to file a lawsuit by themselves. However, a large number of such errors may justify a lawsuit. Your evidence must show these errors call the drug’s performance or safety into question.

Assume for this example that a company tells the FDA that it will use a sterile lab for a particular process. The company then decides not to use a sterile lab because it’s too expensive. The FDA could consider the drugs made without the sterile lab to be non-conforming. This scenario could thus qualify as drug fraud.

Pharmaceutical fraud is complex and often hard to prove. Find out more about how pharmaceutical whistleblower lawyers can help by contacting the Bothwell Law Group.