Understand the importance of a qui tam Medicare lawsuit.
Do 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.