Whistleblowers Archives - National Whistleblower & Government Fraud Settlement Attorney

What Types of Cases Do Qui Tam Lawyers Handle?

Posted on October 9, 2017October 3, 2017 by Mike Bothwell

Since the False Claims Act was amended in 1986, qui tam lawyers are now able to work with ordinary citizens who want to blow the whistle on fraudulent use of government funds. This amendment allows the relator to pursue a portion of the recovered funds as a reward for filing a complaint against the organization or company committing fraud. Also, the law protects relators against retaliation of any kind. The law equips them to pursue compensation if they are the victims of retaliation as a whistleblower.

There are various types of cases qui tam lawyers handle. Each has its own unique set of circumstances to consider when filing a claim. The qui tam lawyers at Bothwell Law Group can assist you in filing a claim, increasing the chances of you receiving the reward you deserve for your actions.

Continue reading below to learn more about the types of cases handled by qui tam lawyers:

Defense Contracting

First of all, sometimes contractors with the U.S. government falsely report information concerning a product they manufacture for the U.S. military. Or, they may charge the U.S. government for a service, product, or supply they provide the military. Hence, they may be liable in a qui tam lawsuit.

Medicare and Medicaid Fraud

If a healthcare organization is submitting fraudulent claims to Medicaid or Medicare, they may be liable in a qui tam lawsuit. Fraudulent activity could include billing for services not received. Furthermore, misrepresenting services received, or misdiagnosing a patient to allow for billing of additional services is prohibited.

Unreturned Overpayments

Also, healthcare organizations guilty of failing to return overpayments made by Medicare or Medicaid may be liable in a qui tam lawsuit.

Bid Tampering

In addition, companies contracted to provide services or products to the U.S. government sometimes tamper with or “rig” the bids in the contract. They may be liable in a qui tam lawsuit. Bid-rigging most commonly occurs with companies agreeing in advance among themselves to bid a certain way. Hence, one company will win while the other collects “loser fees.”

Upcoding

Finally, healthcare agencies sometimes bill Medicare or Medicaid for a more serious diagnosis or more expensive procedure. They hope to obtain over payment for an unnecessary service. They may be liable in a qui tam lawsuit. In some cases, this also takes the form of unbundling. Certain medical tests and procedures are typically billed in a bundle. In some cases, healthcare providers will unbundle these procedures in order to obtain further compensation or disguise double billing.

Do you have evidence of defense contracting fraud, Medicare or Medicaid fraud, bid-tampering or any other fraudulent activity? You may have grounds for a qui tam lawsuit. You can learn more about filing a False Claims Act lawsuit. Most of all, if you call 770.643.1606, you can speak with an experienced qui tam lawyer at Bothwell Law Group.

Is There a Difference Between Whistleblower Attorneys and Qui Tam Attorneys?

Posted on June 12, 2017June 5, 2017 by Mike Bothwell

Qui tam attorneys offer invaluable consultation and representation to whistleblowers. A whistleblower is anyone who reports illegal activity occurring in an organization. In contrast to the disgruntled employee who attempts to discredit a company by spreading rumors, the whistleblower has hard evidence to support his or her claims. While some alarm sounders in past times have been former employees of an organization, a whistleblower can be anyone with facts.

When considering the various sub-divisions within the overarching field of whistleblower law, qui tam justice emerges as one division. But just what is this area of law, and is it any different from whistleblowing?

Here are answers to some of the questions you may have regarding qui tam attorneys:

What Is Qui Tam Law?

Qui tam is a division of whistleblower law that specifically seeks to protect the government from fraud. The area covers various government programs, such as Medicare and Medicaid, and protects individuals who report deception to the government.

Can You Give an Example of Qui Tam Law?

Individuals who reap the benefits of Medicaid when they can pay for personal insurance defraud the government by withholding information about their income. They report gross earnings that are well below the poverty line to qualify for Medicaid all while bringing in wages that can fully support their way of life. These individuals may just claim Medicaid, or they may take things a step further by using the income reported to qualify for other government funded programs. Reporting such activity to the proper authorities would fall under qui tam law since government programs are involved.

How Does a Successful Qui Tam Case Impact the Economy?

The government spends billions of dollars every year on programs that suffer from extortion. Your willingness to blow the whistle on such illegal practices keeps money in the system. This allows the government to fund other efforts that would ordinarily go on the back burner due to low capital.

In What Way Is the Whistleblower Protected in a Qui Tam Case?

The False Claims Act serves as a shield for those who place their reputation on the line for reporting fraud. According to the statute, whistleblowers are to be rewarded in instances where their tip allowed the government to recover some or all of funds lost. Experienced qui tam attorneys ensure their clients receive what is due regarding payment.

What Else Does the False Claims Act Do?

The regulation gives any citizen the right to report fraud. Whether or not the citizen has a direct affiliation with the company or person committing the act, he or she can file a fraud report. The law also ensures that suits are “under seal”. This means the whistleblower can remain completely anonymous throughout the investigation process. Cases are usually “under seal” for 60 days but typically there is an extension by a judge who gives the government time to partner with qui tam attorneys and look into the matter.

How Does a Qui Tam Case Come to a Resolution?

Just as with an ordinary whistleblower case, all evidence is weighed to determine whether or not there is a crime. The government takes action against the company or person responsible and rewards the whistleblower if there has been a violation. The government will not provide payment to the alarm sounder if it determines the evidence is not substantial or factual.

Bothwell Law Group protects whistleblowers and brings fraudsters to justice. Call us to learn more about qui tam law and our qui tam attorneys online.

9 Tips for Whistleblowers from Experienced Qui Tam Law Firms

Posted on August 22, 2016August 23, 2016 by Mike Bothwell

Why should you go to an experienced qui tam law firm when you are building a whistleblower case? When you need to get something done right, you want advice from the experts, right? If you’re looking to invest in stocks, you find a Wall Street broker for the best tips. If you’re redecorating your home, you call a top designer. If you’re building a whistleblower case, you look to experienced qui tam law firms for tips.

Are you considering a whistleblower case? Keep in mind these nine tips from Bothwell Law Group:

1. Get a qualified attorney.

The single most important thing you can do as a whistleblower is to hire an experienced attorney. You need a lawyer familiar with the whistleblower laws and one who is familiar with the entire process. Not only can a good attorney help you determine if you have a whistleblower case, but he will keep your best interests in mind throughout the whole process.

Your employer will look out for their protection, and the government’s prime concern is the recovery of the assets fraudulently taken from them. Hire a qualified attorney who knows all the ins and outs of whistleblowing to help you protect your job and recover your reward.

2. Keep copies.

When you bring evidence of the fraud to either your employers or to the attorney general, make sure you keep copies of everything. You may never need them, but if you do, they’re invaluable. Also, keep copies of any positive remarks about your employment, such as reviews and recommendations. These are important if your employer attempts any retaliation disguised as a work performance issue.

3. Document everything.

If you’re considering building a whistleblower case, it’s imperative to document everything you can. Keep track of dates, conversations between involved parties, appointments that might be pertinent and anything else that might be related to the fraud. Keep a hard copy of everything, not just a digital copy. If your only documentation is on the computer and something happens to your hard drive, you will be left with nothing

4. Report to authorities promptly.

Once you’ve determined that fraud is going on, you need to report it, face to face, to the attorney general of your state. There are statutes of limitations for whistleblower cases. Also, only the original reporter is eligible for a reward. By delaying too long, you are taking the chance of someone else reporting the activity, and you lose any opportunity for the reward of up to 15%-25% of the amount of money recovered.

5. Save some cash.

Whistleblower laws protect you against any retaliation at your job. According to the law, you cannot be fired or passed over for promotions or wage increases. Harassment, in any way, including a change in hours, benefits or status, is against the law. Although the law is clear, that doesn’t mean your employer won’t try to dismiss you, forcing you to fight legally to get it back. If you can save some money before moving ahead with your suit, you will eliminate a significant amount of stress.

6. Keep it quiet.

Whistleblower cases are kept under seal while the government investigates the case. The seal means everything is kept anonymous and private. You are not allowed to discuss any of the particulars of your case, or even the fact that an investigation is taking place. Don’t risk the situation by speaking about it to the press or anyone else until the court seal is removed.

7. Be specific.

You’ve heard the adage about the three most important things in real estate being location, location, location. In a whistleblower case, it could be said the three most important things are specifics, specifics, specifics. Keep track of exact dates, timecards, participants in phone conversations or meetings, dollar amounts, billing dates, and any other details you have. The more specifics you provide, the tighter your case will be.

8. Be careful about whom you trust.

Whistleblowing is not something to take lightly. It’s a matter of felony fraud at a federal level, which can mean serious prison time and hefty fines if proven to be false reporting. Many times, the scam involves a significant number of people cooperating for a payoff. Be extremely careful whom you trust – especially at your job. You can’t be sure who might a part of the illegal activities – or who might blow the whistle on you and your suspicions. Make certain that what you think is happening actually is. Get copies of evidence and keep them offsite, never at work.

9. Don’t sign anything.

You may decide to bring your allegations to your employer before you go to an attorney. Many companies have specific procedures set up for reporting fraudulent activity or any other criminal behavior. Should you choose to do this, make sure you do not sign anything indicating an agreement to refrain from a lawsuit or showing any financial compensation in return for dropping the allegations. Not only will this eliminate any possibility of you receiving your rightful share of the recovered money, but it could also implicate you legally. Don’t sign anything until you show it to your attorney.

It’s possible to build a compelling qui tam case resulting in both knowing you helped right a wrong and receiving a potentially substantial reward. The first step is finding a law firm that knows how to help you. Visit us Bothwell Law Group online to learn more about the benefits of working with experienced qui tam law firms.

Top Medical Insurance Fraud in the News

Posted on June 6, 2016June 4, 2016 by Mike Bothwell

Of 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.

$202 Million GA Medicare Fraud Case Starts Aug 3

Posted on July 13, 2015July 24, 2015 by Mike Bothwell

Another Medicare Fraud Case under the False Claims Act

The Department of Justice (DOJ) intends to prove AseraCare is liable under the False Claims Act “because it caused non-terminally ill patients to prematurely give up curative or rehabilitative care so that the company could bill Medicare for hospice payments” according to DOJ attorneys.

A court document from the DOJ attorneys stated “In short, the United States’ told U.S. District Court Judge Karon Bowdre in one court document. “To the contrary, the United States brought this case based on evidence that AseraCare marginalized doctors, systematically pressured its own clinical staff to admit and keep ineligible patients, submitted false hospice claims for patients who were not terminally ill, and was put on notice from internal and external audits and employee complaints that this was occurring.”

Trial Date Set for August 3

A federal judge in Birmingham set a trial date of August 3 for this lawsuit which began when half a dozen AseraCare employees in Georgia, Alabama and Wisconsin filed whistleblower cases.

According to Patrick Burns, co-director of the Washington nonprofit Taxpayers Against Fraud Educational Fund, “It will be, far and away, the biggest hospice (FCA) case.”

Why $202 Million?

The DOJ analyzed random samples of 2,181 AseraCare patients for whom the company billed Medicare for at least 365 consecutive days of hospice care. Patients were with AseraCare for two periods: Jan. 1, 2007 and Dec. 31, 2008 and between Jan. 1, 2009 and Feb. 28, 2011.

The findings: The DOJ argued more than half of the 233 cases should have been deemed ineligible for hospice care.

“Having a few patients who live longer than six months is expected”, Burns said. “That should be one in a hundred, not fifty percent,” he said.

DOJ claims Medicare suffered nearly $67.5 million in damages due to the False Claims Act violations. According to the DOJ’s motion, if the jury awards the $67.5 million, then the judge is obligated under the law to treble the actual damages and award the U.S. a total of $202,481,144.

Congress created the Medicare hospice benefit in 1982. According to court documents, Roughly 90 percent of hospice patients are now covered by Medicare and/or Medicaid.

We will keep you posted on the events of this case. The law firm for the whistleblowers in this case is Frohsin & Barger LLC.

If you know of any Medicare or Medicaid fraud, contact a Whistleblower Attorney today!