False Claims Act

Mark Mandell, Esq.

 

The False Claims Act has recovered approximately $18.3 billion dollars for the federal government from 2008 through 2012. For every dollar the government invests in fighting healthcare fraud, the government gets $16 dollars in return.

The False Claims Act is a Civil War era law, dating back to 1865. The Act is meant to fight companies who defraud governmental programs. People that are not affiliated with the government are also allowed to file actions on behalf of the government; this is known as “whistleblowing”. Whistleblowers can receive up to 15-25% of recovered damages. 

In the past two years, there has been a tremendous increase in healthcare fraud cases. For example, in 1987-1992, there were only 62 healthcare fraud cases filed by “whistleblowers”. The number of cases in 2011 and 2012 add up to 829 cases.

Supporters of The False Claims Act explain that this revenue actually returns a large amount of money to U.S. tax payers. The report from the Washington based group, D.C.-based Taxpayers Against Fraud, states that this revenue can fund the entire Children's Health Insurance Program, serving more than 5 million people, for approximately four years.

 

Although, there are many supporters of the act, there is also some opposition. For example, the U.S. Chamber of Commerce believes that this act needs a lot of reform to encourage companies to try to fix the fraud issue internally. Penalties for healthcare fraud are actually three times the amount of the actual damages and the Chamber of Commerce explains that these penalties are handed out without any due process. The Chamber of Commerce explains that these penalties are too harsh and this makes companies less likely to come forward and ask for help in solving their issues with internal fraud. For example, the Chamber of Commerce thinks a good idea for reform would be to create benefit incentives for companies who create in house programs against fraud.

Healthcare fraud continues to be a serious problem and initiatives to fight healthcare fraud continue. For more information please read:

http://www.beckershospitalreview.com/legal-regulatory-issues/u-s-recovers-16-for-every-1-it-spends-fighting-civil-healthcare-fraud.html

http://www.mainjustice.com/2013/10/23/u-s-chamber-of-commerce-proposes-false-claims-act-reforms/

Multimillion Fraud Award

Mark Mandell, Esq.

 
In this era of increasing health care costs and budget constraints, allegations of Medicare fraud need to be aggressively pursued to maintain the integrity of the system.  On October 15, 2007, Gale Bryden filed a lawsuit against her former employer, Wyoming Medical Center (WMC), under the whistleblower provisions of the False Claims Act.  Ms. Bryden alleged that WMC had committed Medicare Fraud.

Specifically, Ms. Bryden stated that WMC submitted requests to Medicare for reimbursement that were inconsistent with patient records, changed the admission status of patients without a physician order, and billed Medicare for unnecessary inpatient admissions.

The United States conducted an extensive investigation and found evidence to support the allegations of fraud.

The WMC settled this case with the United States and must pay $2.7 million in damages arising from the alleged fraud.  Ms. Bryden, as compensation for filing the case and assisting the United States in its investigation, will receive a share of this settlement.  The assistance of citizens like Ms. Bryden is essential to combat this abuse of the system.  Corporations allegedly seeking to increase profits at the expense of taxpayers can expect aggressive investigation.

If you have questions or have witnessed Medicare fraud, contact the experienced fraud team at Fausone Bohn, LLP.  Call us at (248) 380-0000 or visit our website at www.MichiganFraudLawyer.com.

To read the original article, please visit:

http://www.kgwn.tv/story/19689697/settlement-reached-over-medicaid-fraud