By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Individuals working in the health care industry, whether for hospitals, nursing homes, medical groups, home health agencies or others, often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government.
This is the second blog in a two-part series on whistleblower/qui tam lawsuits. In the first blog I explained types of false claims, the reward programs for coming forward with a false claim, and who can file a whistleblower/qui tam lawsuit. Click here to read the first part of this blog.
What You Need to Be a Successful Whistleblower and Receive a Reward:
1. Knowledge that false, inflated or upcoded claims are being submitted for payment to any state or federal program, including the Medicare program, the Medicaid program, TRICARE/CHAMPUS, the Veterans Administration (VA), etc.
2. Copies of documents that show or demonstrate the false claims that are being submitted to the government, such as claims forms, superbills, medical records, etc.
3. Copies of e-mails, letters, memos, guidelines, lectures, inservices, etc., that show the procedures used to promote the filing of false claims by organization employees.
4. The names, addresses, telephone numbers and positions of any other witnesses. Usually former employees make the best witnesses because they are not afraid of getting fired or retaliation if the employer finds out they are witnesses in the case. They are usually more likely to speak freely about the matter than present employees.
5. Information on the organization of the employer, institution or group that is submitting the false claims or benefiting from the fraud. This can include employee directories, organizational charts, "wire diagrams," chain of command charts, contracts with providers, etc.
6. Any documents that show that the employer or institution making the fraudulent claims has knowledge that its activities may not be proper. These may include, for example, e-mails or correspondence from higher-ups in the corporate structure, such as from headquarters, prior inspections or internal audits that have disclosed the fraudulent activities and warned against continuing the same activity.
7. Any industry or professional guidelines that show that proper services or properly supervised services are not being rendered. This includes having the health professionals with proper licenses to deliver services or supervise services. Such documentation may include guidelines or standards written by certifying or accrediting agencies, such as The Joint Commission, the American Academy of Anesthesiology, the American Academy of Radiology, etc. It may include state licensing regulations that place certain restrictions or requirements on those performing such health care services.
How Much Whistleblowers Can Actually Make.
Under the Federal False Claims Act, a whistleblower (qui tam relator) can receive up to thirty-five percent (35%) of a recovery made by the government, plus his/her attorney's fees and costs. If the whistleblower lawsuit results in a settlement or recovery by the government of ten million dollars, for example, the whistleblower could receive up to $3.5 million, plus payment of the attorney’s fees and costs involved. The government tries to encourage those who know of fraud being committed to come forward and report it so that the government can recover as much of the fraudulent proceeds as possible. Most states have similar laws allowing similar recoveries for claims made against state programs such as Medicaid.
Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.
Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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