Medicare kickback lawsuits occur fairly often when litigating the False Claims Act
The False Claims Act is a law designed to fight fraud. One of the biggest areas of fraud against the federal government is in the healthcare industry. Specifically, Medicare is a popular area for fraudsters. They work hard to steal government money with the kickback being one of their tools of choice. But before we can answer the question of what happens during Medicare kickback lawsuits, we need to understand what a kickback is.
What Are Medicare Kickback Lawsuits?
A kickback is a little bit like a bribe, where someone receives a payment in return for sending business to another person or company. Let’s look at an example to explain a kickback.
Imagine a doctor’s office that treats patients who receive Medicare benefits (Medicare is a federally-run health insurance program for older Americans). The doctor’s office may treat the patients, but the federal government actually pays the bulk of the medical fees the patients incur at the doctor’s office. This doctor’s office can be a part of a kickback plan in several potential ways.
First, the doctor’s office could pay people to serve as fake patients. With a fake patient, the doctor’s office can then bill the federal government for medical services that no one ever received. In return for having a person pretending to be a patient, the doctor’s office can pay the fake patient a cut or commission (this is the kickback) of what the doctor’s office received from the federal government.
Second, the doctor’s office has a special agreement with another healthcare provider, such as a hospital. This hospital will refer patients to the doctor’s office for additional medical care they do not need. In return for this extra business and the opportunity to further bill the government under Medicare, the doctor’s office will make a payment, or kickback, to the hospital.
Unless the federal government audits or investigates all the medical providers in the country, it will be impossible for the government to learn of every instance of Medicare fraud. And as you might imagine, the government doesn’t investigate every single medical care provider. Therefore, it must rely on whistleblowers to bring this fraud to its attention. The existence of this whistleblower helps shape what happens during a Medicare kickback lawsuit.
What Will Happen in a Medicare Kickback Lawsuit?
The first thing that will usually happen is a whistleblower reporting the fraud to the appropriate government authorities. One way to do this is by reporting the fraud directly to the federal government. For individuals wishing to take advantage of the False Claims Act’s qui tam provision, they will notify the federal government only after filing the appropriate qui tam complaint in federal court in secret. Besides the court, the only other party who will know about the qui tam lawsuit will be the government. This secrecy will only last until the federal government completes its investigation.
After the federal government receives notice of the qui tam lawsuit, it will investigate the alleged fraud. The government has 60 days to conduct its investigation, but that’s rarely enough time. So the government usually gets extensions to continue its research. Once the investigation is complete, the federal government will make a decision. Here, they’ll decide whether or not it should take over the qui tam lawsuit from the whistleblower (now called a relator) or allow the relator to continue the qui tam lawsuit themselves.
The Government’s Response
Because of the massive amount of resources of the federal government, it’s a good sign if they want to take over the lawsuit from the relator. If the government declines to take on the case, it’s usually a bad sign for the relator. Declining the case usually means either the government doesn’t have a strong case. Or it could mean there is not much hope of recovering a large amount of money. Because of this, a person or organization alleged of fraud under the False Claims Act will feel hopeful that they can win the case if they see the federal government decline to become a part of the lawsuit. They might fight harder in court and make the relator’s legal case more difficult to win.
In part three of the Medicare kickback litigation process, the trial takes place. During the trial, the individual or organization charged with Medicare fraud tries to defend itself in court. If the federal government or relator wins its case, then the relator will receive its share of the recovered money. This usually ranges anywhere from 15 to 30 percent. It depends on how helpful the relator was and if they had any involvement in the fraud. Most relators can expect around 25 percent of the money the federal government recovers from the person or organization committing the fraud.
Looking to Find out More about Medicare Kickback Lawsuits?
Contact the skilled Medicare kickback lawsuit attorneys at Bothwell Law Group by calling 770.643.1606 today.