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Healthcare Fraud

Government Fraud

At At Campbell Law, our firm has experience representing healthcare industry whistleblowers that expose illegal activities involving government healthcare programs. Congress created various healthcare programs for the military, federal employees, and vulnerable members of our society. Examples include the TRICARE Program for the military, the Federal Employees Health Benefits Program for federal employees, the Medicaid program for the poor, and the Medicare Program for seniors and the disabled.

The most common fraudulent schemes committed by providers of healthcare products and services include: billing for unprovided services; billing for medically unnecessary services; upcoding (billing for a different, more expensive service); unbundling (separating package procedures into component procedures to increase billing); falsely diagnosing patients to perform unnecessary procedures; misrepresenting procedures for non-covered services (e.g., cosmetic surgery) as covered services; billing a patient more than the co-pay amount for services that were prepaid or fully paid by a government insurance plan; engaging in a pattern of waiving patient co-pays or deductibles; and accepting kickbacks for patient referrals. If you have inside information of illegal activities involving healthcare products and services that are partially covered by government insurance programs like Medicare, contact our firm for a confidential consultation to protect your rights and to determine whether you have a claim under the False Claims Act, as described below.

False Claims Act Overview

The following content is for informational use only obtained from the National Whistleblower Center, a non-profit organization dedicated to advancing and protecting the rights of whistleblowers based in Washington, DC.

What is the False Claims Act?

The False Claims Act is 31 U.S.C. Sections 3729 through 3733. Qui tam, under the False Claims Act, allows persons and entities with evidence of fraud against federal programs or contracts to sue the wrongdoer on behalf of the United States Government. In qui tam actions, the government has the right to intervene and join the action. If the government declines, the private plaintiff may proceed on his or her own. Some states have passed similar laws concerning fraud in state government contracts.

What Actions Are Considered Violations under the False Claims Act?

Knowingly presenting (or causing to be presented) to the federal government a false or fraudulent claim for payment; Knowingly using (or causing to be used) a false record or statement to get a claim paid by the federal government; Conspiring with others to get a false or fraudulent claim paid by the federal government; Knowingly using (or causing to be used) a false record or statement to conceal, avoid, or decrease an obligation to pay money or transmit property to the federal government.

Who Can File a Qui Tam Action?

Any persons or entities with evidence of fraud against federal programs or contracts may file a qui tam lawsuit. However, if the government or a private party has already filed a False Claims Act lawsuit based on the same evidence as you, you cannot bring a lawsuit.

Where Should a Qui Tam Action Be Filed?

A qui tam action must be confidentially filed under seal in federal district court in accordance with the Federal Rules of Civil Procedure. A copy of the complaint, with a written disclosure statement of substantially all material evidence and information in the plaintiff's possession, must be confidentially served on the US Attorney General and the US Attorney for the district in which the complaint is brought. An action under the False Claims Act must be filed, in camera and under seal. The complaint and its contents must be kept confidential until the seal is lifted. The complaint is not served on the defendant. If the plaintiff violates the provisions of the seal, his or her complaint could be dismissed.

What Are the Civil Penalties Under the False Claims Act?

Violators of the False Claims Act are liable for three times the dollar amount that the government is defrauded and civil penalties of $5,000 to $10,000 for each false claim. A qui tam plaintiff can receive between 15 and 30 percent of the total recovery from the defendant, whether through a favorable judgment or settlement. To be eligible to recover money under the Act, you must file a qui tam lawsuit. Merely informing the government about the violation is not enough. You only receive an award if, and after, the government recovers money from the defendant as a result of your suit.

What Are the Statutes Of Limitations for Filing a Qui Tam Lawsuit?

Under the False Claims Act, an action must be filed within the later of the following two time periods: (1) Six years from the date of the violation of the Act; or (2) Three years after the government knows or should have known about the violation, but in no event longer than ten years after the violation of the Act. (One Circuit Court has interpreted the second provision as requiring that the action be filed no later than three years after the qui tam plaintiff rather than when the government knows, or should have known about the violation.)

What Are the Whistleblower Protection Provisions in the False Claims Act?

Under Section 3730(h) of the False Claims Act, any employee who is discharged, demoted, harassed, or otherwise discriminated against because of lawful acts by the employee in furtherance of an action under the Act is entitled to all relief necessary to make the employee whole. Such relief may include: Reinstatement; Double back pay; and Compensation for any special damages, including litigation costs and reasonable attorneys' fees. You should be aware, however, that the scope of whistleblower protection under Section 3730(h) is an issue that currently divides the courts. Many states have wrongful discharge or other employment laws that may provide other remedies for such discrimination. The Statute of Limitation for filing a False Claims Act retaliation case is different than that for filing a qui tam recovery case. A False Claims Act retaliation case must be filed under the statute of limitation applicable to the most closely analogous state statute.

What about State False Claims Acts?

Due to the success of the Federal False Claims Act, a growing number of states have enacted state versions of the False Claims Act. These laws permit whistleblowers to recover a "finders' fee" for reporting fraud in state, local, and municipal contracting.
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