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Whistleblower & Qui Tam

Whistleblowers cannot be replaced and serve an integral role in our society. When a healthcare organization submits false claims to the government it may be liable for fines, civil damages, and disgorgement of profits, among other things. Our society relies on whistleblowers to do the right thing and report fraud when it happens. By revealing major wrongs that would otherwise be unknown to the public, whistleblowers play an important role in protecting the public. Contact our office today to receive more information about the role whistleblowers play in reporting fraud.

Fraud committed by healthcare organizations against the government is often impossible to detect without the help of whistleblowers. It is estimated that billions of taxpayer dollars have been overpaid to healthcare organizations because of fraudulent billing practices and other types of healthcare fraud every year. By choosing to blow the whistle on healthcare fraud, you may help recover money stolen from taxpayers and could receive a financial reward for your integrity and willingness to do the right thing. Our attorneys will meet with you to review the facts of your case and help you navigate the issues, so you can make an informed decision.

Who can be a Whistleblower?

Any former or current employee of a hospital, nursing home, hospice, or other healthcare organization who has knowledge of overbilling, the payment or receipt of illegal kickbacks, or other schemes to defraud the government may be able to file a whistleblower lawsuit. Independent contractors, consultants, and other individuals who have knowledge of healthcare fraud may also be eligible to take legal action.

Common Types of Healthcare Fraud

  • Billing for medical services not provided to the patient
  • Billing for supplies that were never purchased or used
  • Admitting patients to healthcare facilities who do not meet the eligibility requirements to bill Medicare or Medicaid
  • Upcoding – i.e., manipulating billing codes to bill for more expensive procedures or tests
  • Unbundling – Billing related procedures separately to obtain higher levels of compensation from Medicare or Medicaid. This involves related procedures or lab tests that were performed together and should be billed using a single code
  • Paying kickbacks to healthcare organizations and/or providers in exchange for referring patients to the healthcare facility
  • Mischaracterizing medical services to receive reimbursement from Medicare and Medicaid
  • Overcharging the costs of medical services

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