A health care qui tam attorney needs a case that involves a direct party—usually an employee or former employee—bringing a case of fraud against the government. It’s a case filed under the False Claims Act, which was developed to protect the government against fraud. Many circumstances leading to fraud involve
Medicare or Medicaid, both of which are federally regulated programs to pay for medical services. Health care qui tam cases can also include nursing home fraud, pharmaceutical fraud, medical device fraud, hospice or home health fraud and healthcare scams.
Here are a few examples of health care fraud activities that might be involved:
- Billing for services not provided
- Billing for more expensive services than the ones performed
- Delivering more expensive services than were medically needed
- Misrepresenting the diagnosis to justify payment
- Creating false documentation to support payment
- Billing under the provider number of a different doctor than the one who performed the procedure
- Performing medical procedures without a physician supervising
- Backdating procedures for a time the patient was insured
- Kickbacks and Stark Law violations
- Billing for “overflow” of medicine
- Off-label marketing of pharmaceuticals
You may wonder if the information you have is enough to file a health care qui tam case. While every case is individual, knowing the basics of what an attorney needs to prove a case could help you determine if you’re heading in the right direction.
It’s like packing for the family summer vacation. If you leave everything to memory and guesswork, you’ll likely forget something important. If you make a list of all the essentials, you stand a much better chance of getting to where you’re going with everything you need. You know that will save you time- and probably a whole lot of hassle and expense than if you just pack off the cuff.
Here are some things your health care qui tam attorney needs to prove a case:
Your Health Care Qui Tam Attorney Needs to Know the Timeframe
One of the first things to knock off your qui tam case checklist is when the fraudulent activities took place. There is a statute of limitations of six years in false claims acts. Some circumstances fall outside this boundary, but your attorney needs to know when the fraud took place.
Documentation of dates can be one of the most powerful pieces of evidence in a health care qui tam case. This record will serve to prove the timeframe is within the statute of limitations.
Your Health Care Qui Tam Attorney Needs to Have Credible Information of Fraud
You may be aware of fraudulent activity at your place of employment due to your expertise and experience. Your health care qui tam attorney will talk with you about the information you are aware of and help determine if it is credible enough to provide the basis of a case. This information may be verbal, or you may have physical evidence. Physical evidence is tricky and can be difficult to obtain. Talk with an attorney who is knowledgeable about false claim act suits and he or she will be able to determine the credibility of what you know.
When you meet with your health care qui tam attorney, bring any proof you have as evidence of the fraudulent act. Your evidence can include things like receipts, copies of fraudulent paperwork or bookwork and other items that may be in your possession. Your attorney will have a staff to investigate and gather evidence and will assist you in determining if that evidence is sufficient for a qui tam case.
Your Health Care Qui Tam Attorney Needs to Determine If You Are an Original Source
Only one person can bring a particular qui tam case. If the fraud has already come to the attention of the government, you cannot bring a separate case. Your attorney will research and find out if you are the original source of the alleged fraud. Your information comes from inside information, if you are the primary source, not from something you read about or heard about somewhere else.
Your Health Care Qui Tam Attorney Needs Knowledge to Prove a Case
It’s important to choose an attorney who knows qui tam law in the health care field. The details matter in any lawsuit and with qui tam cases there are an awful lot of rules and regulations governing every aspect of the process. Also, if the government chooses not to intervene, you need an attorney with the wisdom to know if you should proceed on your own or not. Choose an attorney who has successfully argued health care qui tam cases in the past, so you can trust he or she will make solid decisions.
Learn more about the benefits of using a health care qui tam attorney by contacting the Bothwell Law Group online.