Contact our Georgia national whistleblower lawyers today. Call us at 770-643-1606

Top Medical Insurance Fraud in the News

Medical Insurance Fraud

Medical Insurance FraudOf all cases of medical insurance fraud that occur each year, Medicare fraud is the largest source. In 2014, fraudsters scammed Medicare for over $60 billion, and over 2,000 providers have been caught defrauding Medicare. Pursuing Medicare fraud can be difficult due to the prevalence of fraud as well as the sheer number of people involved in defrauding Medicare.

What Is Medical Insurance Fraud?

Medical insurance fraud occurs when a provider or consumer intentionally submits fraudulent information that is used to determine health care benefits payable. Because of the cost of health care and medical equipment, the idea of pocketing the payout of billing for services or equipment that were not rendered is a tempting one for providers and consumers alike. While Medicare is the organization that is most affected by fraud, it can affect any heath insurance company, and can be perpetuated by individual doctors as well as organized groups.

Medicare and related government-provided coverage is the most common target for insurance fraud for a few primary reasons:

  • Over 54 million people are covered by Medicare, and the organization pays out over $600 billion each year.
  • The organization is subjected to the loosest monitoring by those in charge.
  • Billions of dollars are left largely unguarded and ripe for targeting by scam artists.

How Is Medical Insurance Fraud Perpetuated?

There are various ways providers and consumers can commit medical insurance fraud. Some of the most common seen by investigators include the following:

  • Billing for medical equipment, medication, or services that were not actually rendered, received, or performed.
  • Falsifying a patient’s diagnosis to justify procedures, equipment, surgery, or other procedures that were not medically necessary.
  • Upcoding and Unbundling. Upcoding is billing for a service more costly than the one performed. Unbundling is the billing of each step of a procedure as separate procedures.
  • Accepting kickbacks in exchange for patient referrals.
  • Waiving co-pays or deductibles and over-billing the insurance company.
  • Forging or alteration of medical bills or receipts.
  • Using someone else’s health coverage or insurance card.

Combating Medical Insurance Fraud – a Lengthy Process

Medical insurance fraud is a crime that has serious ramifications for everyone. Every time fraud is committed, it raises the cost of health care for millions of other Americans. So it is important that medical insurance fraud is pursued and prosecuted in order to recoup the amounts that were defrauded.

The challenge in pursuing insurance fraud is finding individuals who are both willing to cooperate with investigators and who have sufficient evidence to back up their claims. Even when a whistleblower contacts authorities with information, it can be a long and arduous process to gather more evidence and bring a court case. But these cases must be pursued in order to help combat the rapidly-rising costs of health care in the United States.

If you have witnessed or participated in medical insurance fraud, you will need protections should you choose to come forward as a whistleblower. Contact the skilled whistleblower attorneys at Bothwell Law Group by calling 770.643.1606 today.

3 Steps to Follow when You Need to Know How to Report Healthcare Fraud

how to report healthcare fraud

how to report healthcare fraudIf you’re wondering how to report healthcare fraud, you’re probably already in an uncomfortable position. Someone you work for (or with) is doing something illegal to defraud the government and the healthcare system it supports. You’ve found out, and now you think you need to do something about it.

Here are the steps you should follow if you ever think you need to file a report:

How to Report Healthcare Fraud:  Gather Evidence

When reporting any fraud or misconduct, you need more than just hearsay. Ideally, you’ll have a paper trail consisting of invoices, vouchers, emails, database records, and any other physical items that paint the picture about what exactly is going on.

Once you have everything in order, do not talk to anyone about it yet. Not a friend, not your company, and not the press. This is important because the instant you disclose certain information, you lose options. You also potentially implicate yourself in contractual and non-disclosure violations.

Simply gather the information for now, and keep it in a safe place.

How to Report Fraud:  Understand Your Options

You have three main options when it comes to reporting suspected fraud:

  1. Notify the agency being harmed. Each agency has its own Inspector General, responsible for investigating any fraud relating to their department.
  2. Notify the FBI. You can always report fraud anonymously through the FBI tip hotline, or by contacting your local FBI office.
  3. File a qui tam lawsuit under the federal False Claims Act. Under the FCA, individuals can file a civil lawsuit on behalf of the U.S. government.

The first two options above are fairly straightforward, and are certainly good choices in specific and simple scenarios. However, the third option is potentially the most lucrative of the three.

How to Report Fraud:  Consult a Qui Tam Lawyer

In the event you need help making the best choice, or you’ve already decided to file a qui tam lawsuit, it’s time to consult a lawyer. Your lawyer can review the evidence you’ve provided, and help you determine if it’s enough to bring a lawsuit. What your lawyer is looking for is the strength of the evidence, and the size of the fraud in question; both factors will determine your likelihood of success

After reviewing the evidence, your attorney will likely advise on which of the three options is in your best interest given the facts of the case. In the event you decide to proceed with a lawsuit, you can expect them to do the following:

  • File a complaint with the U.S. District court under seal. The term “under seal” means only the government and you are aware a suit has been filed. It gives them time to conduct their own investigation
  • Work with the government to help determine if they want to join your case
  • Carry your case, working with the government (in cases where they intervene), on your behalf

Anything Else You Need to Know about Healthcare Fraud Reporting?

Still have questions about how to report healthcare fraud? Click here to contact the Bothwell Law Group online.

What the False Claim Act for Healthcare Means to You

False Claim Act for Healthcare

False Claim Act for Healthcare The False Claim Act for healthcare is essentially a small component of a much larger set of regulations making it a crime to knowingly record or file a false claim, regarding any federal healthcare program. While Medicare and Medicaid are both considered federally funded programs, it also extends coverage to any plan or program providing health benefits (including through insurance) which receives any funding from the federal government or state-sponsored healthcare system.

Examples of fraud covered under the FCA include billing for services never received, double billing (billing for the same service more than once), or making any sort of false statement in an effort to obtain payment for services.

Penalties Associated with Falsifying Claims

Any violation discovered and prosecuted under the FCA carries stiff penalties. From a financial perspective, an individual or organization is on the hook for three times the amount of the falsified claim, plus an additional penalty of up to $11,000. These penalties are on a per claim basis, so in cases of systematic fraud, the dollars begin to add up quickly.

Violations can also be counted as a felony charge, and result in jail time, additional fines, or both. Anyone found to have received a benefit by way of fraud, made a fraudulent statement, or worked to conceal material facts can be held liable.

Protection for Individuals Reporting Fraud – aka – Whistleblowers

Any employee who reports a violation under the False Claims Act is legally protected from harassment, suspension, or being fired as a result of their reporting. If the court finds the employee did suffer discrimination, they may be awarded two times their back pay (with interest), immediate reinstatement of their original job, and additional compensation for costs incurred and any damages suffered as a result.

When the Qui Tam Provision May Apply

Qui tam is an abbreviation for a Latin phrase that very loosely translates to someone who brings a case on behalf of themselves and their “king”. Basically, it means you can sue someone on behalf of the government, and be paid a percentage of any of the funds recovered as a result of the lawsuit, even if you were engaged in, or a part of, any illegal activities covered by the FCA.

It is worth noting here that any awards received as qui tam payments are considered ordinary income, and taxed as such by IRS. While previous qui tam relators have attempted to have these payments classified as capital gains, the Ninth Circuit Court of Appeals upheld the IRS’ position on income classification.

Think You Have a False Claim Act for Healthcare Case?

Contact the experienced attorneys at Bothwell Law Group by calling 770.643.1606, and find out if the False Claim Act for healthcare applies to your situation.

Does Unnecessary Medical Billing Fall under the False Claims Act?

Unnecessary medical billing

When reading the False Claim Act, it may not seem perfectly clear whether unnecessary medical billing is covered by the law. The False Claims Act is a detailed law, covering multiple industries and various types of fraud. If you suspect a healthcare provider of committing fraud, there are a few things you should know before taking action under the False Claims Act.

What Is Unnecessary Medical Billing?

Unnecessary medical billing can take many forms. In some cases, a physician will bill for a service never provided or upcode a service as a more expensive test or procedure in order to obtain further compensation. In other cases, the healthcare provider will intentionally misdiagnose a patient, knowing this diagnosis will enable them to bill for costlier tests and procedures the patient never needed. Another example of unnecessary medical billing occurs when a patient is provided a service or supply they never needed because the healthcare provider is hoping to receive additional funds.

Not All Unnecessary Medical Billing Falls under the False Claims Act

All unnecessary medical billing is wrong, but not all unnecessary medical billing falls under the False Claims Act. This law was specifically created to allow for prosecution of entities which are misusing government funds. This means, any unnecessary medical billing being paid by Medicare or Medicaid will fall under the law. The False Claims Act allow for citizens to act on behalf on the behalf of U.S. government by filing a complaint.

This is compared to cases where a private insurance company is being billed unnecessarily. This type of insurance fraud is not covered under the False Claims Act, but it is illegal. The private insurance company will need to seek out an attorney who can work with them to file a lawsuit on their behalf.

Reporting Medicare or Medicaid Fraud

If you are the employee at an organization which receives reimbursement for services from Medicare or Medicaid and you suspect fraud is being committed, you can become a whistleblower. If you are a recipient of services being paid for through Medicare or Medicaid, you can also report fraud. Many people choose to report fraud through a hotline provider by the Attorney General in their state. However, if you wish to receive up to 25 percent of the recovered funds as a reward for filing a complaint, you must work with an attorney to file a claim.

An experienced whistleblower attorney will be able to guide you through each step of the process. They can make sure you are protected against retaliation for filing the complaint and they can help you take every possible step to increase your chance of receiving a portion of the recovered funds.

At Bothwell Law Group, we are experienced working with whistleblower lawsuits. To learn more about unnecessary medical billing and the False Claims Act, call 770.643.1606.

Hospice Pays $3 Million in Fraud Claims Settlement

fraud claims settlement

fraud claims settlementIn a recent fraud claims settlement by Bothwell Law Group, Georgia area hospice center Guardian Hospice has reached a $3 million settlement. Together with their affiliated organizations, Guardian Home Care Holdings and AccentCare, Guardian Hospice was accused by a whistleblower of submitting false claims to Medicare and Medicaid.

The false claims submitted were for hospice patients in their care who were not terminally ill and they obtained government funds by providing this false information. Bothwell Law Group used the settling of this lawsuit to pursue justice for two former Guardian employees whose sealed case was filed in 2012. Although Guardian did not admit to being liable for the fraud, they still agreed to a $3 million settlement.

What can we learn from this fraud claims settlement?

Since the whistleblowers in this case filed their claim under the False Claims Act, Bothwell law was able to obtain a $510,000 reward for their actions. In addition to this, two of the whistleblowers believed Guardian wrongfully terminated them. As a result, Bothwell was able to negotiate an additional $50,000 for Rose Betts and $40,000 for Jennifer Williams to resolve the retaliation they claimed to have faced at the hands of their former employers.

In a statement to the media, Bothwell shared that their clients had grown accustom to watching their employer offer hospice care to non-terminal patients. In order to receive reimbursement for their care, the hospice center submitted false claims to Medicare and Medicaid, communicating that these patients were in the last six months of their lives.

In a statement concerning the case, Derrick Jackson, special agent who was placed in charge of the U.S. Department of Health and Human Services Office of the Inspector General, explained why this is such a gross misuse of funds.

“Hospice care is only medically appropriate—and reimbursed by Medicare—for terminally ill patients who are in the last months of their lives,” Jackson stated.

Mike Bothwell, and the entire team at Bothwell Law were honored to work closely with the honest and brave whistleblowers who brought the fraud to the attention of the United States government. Throughout the case if was very clear the U.S. government was not the only victim of the fraudulent actions.

Patients who do not meet criteria for hospice care, but are admitted anyway, miss out on the treatment a traditional hospital would provide, potentially missing a chance for their illness to be cured. Without the actions of the whistleblowers, who were wise when they selected a law firm that was experienced in whistleblower law and fraud claims settlement, this fraud might have continued to be committed in the future.

If you have reason to believe your employer may be committing Medicare or Medicaid fraud, call 770.643.1606 to learn more about filing a fraud claims settlement with our legal team Bothwell Law Group.

10 Reasons to Hire a Medical Malpractice Attorney

Medical Malpractice Attorney

Medical Malpractice AttorneyIf you need to bring a medical claim against a doctor or hospital, you will need help. A medical malpractice attorney can make the difference in winning and losing your case.

Here are the top 10 reason you should hire a medical malpractice attorney:

Reason 1 – Medical negligence is the third leading cause of death in the United States, according to the Journal of American Medical Association (JAMA).

Reason 2 – Over $3 billion was spent in medical malpractice handouts in 2012 alone.

Reason 3 – Proving a physician violated the accepted standard of care is nearly impossible to do alone. In a Medical Malpractice case, it must be proved that a doctor did not uphold the accepted standard of care. If a doctor fails to uphold these standards constitutes negligence.

Reason4 – The defendants attorney will likely try to claim your injuries were not caused by the care your doctor did or did not give you. They may try to claim your injuries were from outside causes. Trying to defend yourself on this point often proves to be difficult. An experienced medical malpractice attorney is skilled at handling what the defense throws at you.

Reason 5 – A medical malpractice attorney can interview the patient, family members and friends to help determine if your case is actionable.

Reason 6 – As there are statutes of limitation, a medical malpractice attorney will be able to help make sure your lawsuit is filed in time. He or she will also make sure the procedural requirements are met.

Reason 7 – You usually won’t have to pay a medical malpractice attorney in advance. The typical fee structure is for a medical malpractice attorney to be paid based on a percentage of what you may collect on a settlement or a judgment.

Reason 8 – An attorney can help you recover as damages: medical bills, pain and suffering, lost earnings and lost earning capacity.

Reason 9 – Medical malpractice attorneys can help you determine if any of the following apply to your case: amputating the wrong body part, failing to diagnose a medical condition during an exam, mistakes monitoring the amount of anesthesia a patient needs, mistakes monitoring the heartbeat of an unborn child during labor, sub-standard trauma care immediately after an severe accident, failing to account for all sponges or instruments following surgery and other such neglectful acts.

Reason 10 – Special requirements exist in a medical malpractice case that do not exist is other types of law suits, such as expert testimony and medical malpractice review panels. A specialized attorney can help acquire the right experts to testify in your case.

Attempting to fight a medical malpractice case alone is often futile. Without the help of an experienced medical malpractice attorney, your case could quickly go awry and you could be left without any compensation for your pain and suffering, medical bills or other damages.

Historical Amount of Medicare Fraud Arrests

Georgia Capital top medical fraud attorney

Despite the historical number of Medicare fraud arrests, more are set to come. 

According to Modern Healthcare reporter Lisa Schencker, “Federal officials announced Thursday the largest coordinated, criminal Medicare fraud takedown—and the first large-scale effort to focus on Medicare Part D fraud—in the history of the U.S. Justice Department.

Over the last three days, the Medicare Fraud Strike Force has unveiled charges against 243 individuals across the country accused of falsely billing $712 million to Medicare in a number of separate schemes, said U.S. Attorney General Loretta Lynch. Those charged include 46 doctors, nurses and other licensed medical professionals.”

Of those arrested, more than 44 have been charged with fraud related to Medicare’s drug benefit program – Medicare Part D.

HHS Inspector General Daniel Levinson said costs in Medicare Part D reached $121 billion last year. “Our focus on Medicare Part D continues because more than 41 million Americans depend on that program, and its integrity must be protected,” Levinson said.

Law firms, like Health Law Partners, are starting to see a lot of fraud enforcement in the pharmacy area.

Medicare Part D More Difficult to Prosecute

Since Medicare Part D payments are capitated, instead of being fee-for-service, prosecuting in this area can be more difficult to prosecute than other areas of Medicade, according to Patrick Burns, co-director of the Taxpayers Against Fraud Education Fund.

Tony Maida, a former deputy chief of the administrative and civil remedies branch of HHS’ Office of Inspector General, also noted in a statement that the announcement Thursday “was packaged together by the government to create a high level of media and public exposure, as well as for a deterrent effect.”

Types of Charges Against the 243 Individuals

In this latest federal effort to crack down on fraud, the 243 individuals accused were charged with a variety of crimes including “conspiracy to commit healthcare fraud, violating the anti-kickback statute, money laundering and aggravated identity theft in areas including home healthcare, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy fraud.”

Who’s Investigating These Cases?

Medicare Strike Force teams from the Fraud Section of the Justice Department’s Criminal Division as well as U.S. attorney’s offices around the country are prosecuting and investigating these cases.

If you are aware of Medicare fraud, contact a Medicare Fraud Attorney as soon as possible.


Endangering Babies For Profit

Bottom line: Medicaid pays the same amount for a Midwife as for an Ob-Gyn. Thus, some hospitals have a financial incentive to push even the high-risk patients to use Midwives rather than doctors. Unfortunately, this is happening at considerable risk and sometimes serious damage to patients.

$100 Million Lawsuit Filed

$100 Million federal law suit was filed against Indiana University Health and 2 associated medical organizations, Healthnet and MDWise.  Allegations state “Contrary to their carefully crafted image of offering compassionate care for the indigent, two of the largest healthcare providers in Indianapolis put poor, pregnant women and their newborn babies at risk with a fraud scheme designed to increase revenues, regardless of the law or the risks to the most medically-fragile patients.”

A doctor at the hospital filed a complaint after what she saw there. Dr. Judy Robinson is the former medical director at the hospital. “I’m filing this lawsuit because of the abysmal care I witnessed these people receiving. And, after approaching IU Health, nobody would do anything.” Robinson pointed out that patients who should have received monitoring during their pregnancy didn’t receive the monitoring. “There was little to no physician involvement in the obstetrical care of these high-risk patients.”

Under the state Medicaid reimbursement rules, “Nurse midwives may not provide services to members with medically high-risk pregnancies. However, according to the lawsuit, lower-cost nurse midwives handled high-risk patients, in violation of the Medicaid regulations.

To make it worse, the hospital filed false-claims with the state and federal government for doctor services the patients never received. The hospitals are using midwives but getting reimbursed for using doctors.

Babies Permanently Damaged

According to Dr. Robinson, at least 3 babies suffered permanent neurological damage and 17 infants nearly missed a tragic outcome.

Watch the TV interview here. 

Thanks to whistleblowers like Dr. Judy Robinson, the lives of children may be dramatically changed for the better.

If you think you may have a whistleblower case, have a confidential talk with a whistleblower attorney as soon as possible. These are time-sensitive matters. A whistleblower attorney knows how to protect your rights and get results.

Children’s Hospital Pays Millions in Settlement

Hospitals around the country have been accused of violating the false claims act.  Children’s Hospital in D.C. is among them.

The allegations against Children’s Hospital

Children’s Hospital, Children’s National Medical Center Inc. and it’s affiliated entities, collectively known as CNMC faced claims of violating the False Claims Act. They are accused of submitting false claims reports and other applications to the Department of Health and Human Services (HHS) and to Medicaid programs in Virginia and the District of Columbia.

Violating False Claims Act Raises Health Care Costs for Everyone

“The false reporting alleged in today’s settlement deprived the Medicare Trust Fund of millions of taxpayers’ dollars,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division.  “Such conduct wastes critical federal health care program funds and drives up the costs of health care for all of us.”
“The integrity of federal health care programs depends on honest and accurate reporting from the hospitals and other health care providers that receive hundreds of billions of tax dollars every year,” said Acting U.S. Attorney Vincent H. Cohen Jr. of the District of Columbia.  “This settlement demonstrates our commitment to defending the integrity of the system and ensuring that taxpayer money goes to meet the most critical health care needs.  We will continue to work with whistleblowers like the former employee who came forward in this case to battle waste, fraud and abuse that fuel the skyrocketing cost of health care.”

The settlement Agreement

Children’s Hospital agreed to pay $12.9 million in a settlement agreement. According to the settlement agreement, in two distinct ways, CNMC misstated information on cost reports and applications.  The HHS and Medicaid programs used the false information to calculate reimbursement rates to CNMC. The United States contended that CNMC falsely reported its available bed count on its application to HHS’ Health Resources and Services Administration under the Children’s Hospitals Graduation Medical Education (CHGME) Payment Program. This program provides federal funds to freestanding children’s hospitals to help maintain their graduate medical education programs. Such programs train pediatric and other residents.

The United States further contended that CNMC filed cost reports which misstated their overhead costs. These false reports resulted in overpayment from Medicare as well as the Virginia and District of Columbia Medicaid programs.

Allegations against CNMC were filed by James A. Roark Sr., a former employee of CNMC, under the qui tam or whistleblower provisions of the False Claims Act.  Under the False Claims Act, a private citizen can sue on behalf of the United States and share in any recovery. The United States is entitled to intervene in a False Claims Act lawsuit, as it did in this case.

From the $12.9 million settlement, Mr. Roark will receive $1,890,649.98.

Health Care Fraud Prevention and Enforcement Action Team (HEAT) Initiative

In May 2009, the Attorney General and the Secretary of Health and Human Services announced the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative. This was done in efforts to combat health care fraud. The two departments are working together to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of their most powerful tools is the False Claims Act.

$24.3 billion has been recovered through False Claims Act cases since January 2009. More than $15.3 billion involves fraud against federal health care programs.
Please note: This particular matter was handled by the U.S. Attorney’s Office of the District of Columbia with assistance from the Civil Division’s Commercial Litigation Branch and the HHS’ Office of Inspector General.
The case is United States ex rel. Roark v. Children’s Hosp., et al., No. 1:14-cv-00616 (D.D.C.).
The claims resolved by the settlement are allegations only, and there has been no determination of liability.


Pharmaceuticals Paying Doctors

Are Doctors Relying on Pharmaceutical Companies to Pay Their Salaries?

More and more evidence seems to indicate that pharmaceutical companies are funneling money into the pockets of doctors who regularly prescribe their medications. This makes many people wonder whether they really need the medications they take, or if they are helping their physicians pay for their cruises, homes, and fancy cars.

The Startling Figures

According to an analysis performed by Modern Healthcare using an Open Payments database regarding Medicare Part D information, some 400 doctors prescribed more than $1 million worth of drugs in Medicare’s Part D prescription program. Of those 400 doctors, 23% received some sort of financial kickback from the drug manufacturer, whether in the form of consulting fees or other perks. As an example, a neurologist in Saginaw, Michigan named Dr. Gavin Awerbuch billed Medicare for more than $6.4 million worth of Subsys, a drug designed to help cancer patients fight pain, in 2013. The Justice Department indicted him last year for the fraudulent prescription of unnecessary medications.

Other Guilty Parties

Dr. Awerbuch is not the only party guilty of receiving money for prescribing medications. Dr. Vallerie McLaughlin, a University of Michigan cardiologist, prescribed nearly $5 million worth of Tracleer to Medicare recipients in 2013. This made her the sixth-highest prescriber of a single drug. What’s more, the manufacturers of that drug, Actelion Pharmaceuticals, a Swiss company, paid her $40,491 that year in clinical consulting fees, meals, and travel. Is that merely a coincidence, or are physicians truly prescribing unnecessary medications just to line their pockets?

Is It Legal?

There is no law that prevents pharmaceutical companies from rewarding doctors who regularly prescribe their medications. However, the drug makers cannot simply write the physicians checks for a job well done. Instead, they pay “consultation fees” to the doctors, which is nothing more than a clever way for the physician to earn a handsome kickback simply for prescribing a popular medication. Often, these fees include things such as luxurious meals, travel accommodations, and more – and sometimes even for the physician’s family, too.

What Does This Mean for Medicare Recipients?

Does this mean that Medicare recipients should be wary of every single drug they are prescribed? In some cases, yes. Although there is no proof that doctors across the country continue to prescribe medications to people who do not need them just to get financial kickbacks, it is happening – and it has been proven in some cases. Medicare recipients who receive prescriptions should carefully question their physicians to determine whether the drug is truly necessary. What’s more, obtaining a second opinion is also an option. Patients should do their own research and assist in determining whether medications are helpful or not necessary at all.

It is certainly sad that physicians who swore oaths to “do no harm” would prescribe their patients to take potent medications, often with severe side effects and the potential for addiction, even when those drugs are not necessary, just to earn some extra cash. It means that consumers must be on their toes, questioning their healthcare teams in times of sickness and health alike.

Average Joe Jailed for Medicaid Fraud

In today’s day and age, federal and state governments work tirelessly to protect the funding for public services such as Medicaid and Medicare. In the past, while the governments focused their fraud watches on hospitals and healthcare providers, they now look at Medicaid recipients themselves, including Melissa Letica Simmons, a 49-year-old woman from Gadsden County, Florida.

The Average Joe vs. Corporate Fraud

Florida Attorney General Pam Bondi said that Simmons, a home healthcare worker in Gadsden County, one of the poorer counties in Florida, had defrauded taxpayers to the tune of $13,000. As such, Bondi played a role in sentencing Simmons to six months in jail. However, just a few years prior, the state accused three major hospitals of defrauding Medicaid to the tune of millions of dollars. There was no criminal prosecution of any of the parties involved, and the hospitals managed an insignificant punishment – they repaid the funds they stole from taxpayers for only pennies on the dollar.

The State’s “Amicable Settlement”

A Floridian fraud case involving many different hospitals resulted in a statement directly from the state, saying it wanted to “resolve this matter amicably with our industry partners.” Thus, a poor woman receives a six-month jail sentence for a $13,000 crime while several large hospitals receive little to no punishment because the state wants an amicable relationship. Prosecutors rarely want amicable resolutions; they want to see the criminal punished to the extent allowed by law.

How Florida Legislature Views Healthcare Fraud?

According to the aforementioned truths, Florida seems to view those who commit fraud alone as evildoing criminals with an intent to steal from taxpayers. However, when an entire corporation is in on the theft, even to the tune of millions of dollars, it is chalked up to clerical error or misunderstanding. Rather than jailing those responsible – or even forcing them to pay back what they stole – these hospitals and other companies settle for just pennies in order to keep their reputations intact. The judge in the corporate case claims that the men involved had “already been punished” with the damage to their reputations.

As it turns out, it would seem that Aesop was right all along. Sometimes, the government chooses to “hang the petty thieves and appoint the great ones to public office” for no other reason than to set an example. With legislators like this, corporations will only continue to commit fraud, while the little guy remains afraid of his own “clerical errors”.

If you need help with a whistleblower law suit, call an experienced whistleblower attorney right away!