Philadelphia Attorneys Knowledgeable About Laws Used to Report Medicare/Medicaid Fraud

The False Claims Act (FCA) involves fraud committed against the federal government or any of its agencies. Many states have their own law including the New York False Claims Act, the New Jersey False Claims Act, and the Delaware False Claims and Reporting Act. Generally speaking, any business entity or individual that does business with the federal government in any capacity has the potential to have a claim against it, which is typically filed under the Qui Tam provision of the FCA. The Qui Tam provision allows a private individual, called a relator, or whistleblower, to report fraud secretly to the United States government and any state attorneys general for states where the fraud took place. Regardless of the dollar amount of each individual fraudulent transaction (it could be as little as $5), the FCA allows for penalties up to $11,000 per transaction, as well as three times that amount in additional damages!

The Law Firm of Jacobson & Rooks, LLC, in Philadelphia, Pennsylvania, has extensive knowledge of the laws that are used to report Medicare and Medicaid fraud. Call us first at 856-208-5748 to arrange a consultation with a lawyer.

Examples Of Medicare/Medicaid Fraud

Examples may involve any company that submits claims to Medicare and Medicaid, such as hospitals, home health agencies, nursing homes, ambulance companies, assisted living centers, pharmacies, pharmaceutical manufacturers, medical laboratories, and X-ray/imaging centers. Of the fraud committed against the government, 80 percent occurs within the health care industry. However, the scope of fraud committed against the government is not limited to health care. Fraud committed against the government may also be perpetrated by other companies that do business with the government, including, but not limited to, defense contractors, affordable housing developers, Section-8 owners, and public educational institutions that receive federal loans/grants that misappropriate those funds or use them for an undesignated purpose. The FCA allows any private citizen having knowledge of such fraud to work with an attorney to file a claim on behalf of the government. The government richly rewards private citizens who bring a successful claim. A successful financial recovery can range from several hundred thousand dollars to several hundred million dollars.

The steps are simple, but they must be followed exactly in order to recover any money. For this reason, an experienced attorney should be used to prepare and file the claim. Putting it simply, among others, there are two main requirements: The private citizen must have firsthand knowledge of the fraud and must be the FIRST person to file the suit.

Anti-Kickback Statute

The Anti-Kickback Statute makes it illegal for anyone to pay a kickback, rebate or bribe as a condition of making a referral of a Medicare or Medicaid patient. The kickback, rebate, or bribe does not have to be cash. It could be in the form of sports event tickets, concert tickets, waiver of co-insurance or deductibles, jewelry, donations made in the name of the referral source, or anything else of value. The Anti-Kickback Statute also makes it illegal to submit false statements or false claim forms to Medicare or Medicaid.

Stark Law

The Stark Law applies to physicians and prohibits a physician from making a Medicare/Medicaid referral to an entity where the referring physician financially benefits. This is referred to as a prohibition on self-referrals, whereby the physician's referral is to an entity where the physician has an ownership interest in or receives compensation from such entity. In addition to prohibiting the self-referral, the Stark Law also prohibits the entity from billing Medicare/Medicaid for the services provided as a result of the self-referral. There are, however, some limited circumstances whereby the physician is permitted to make such referrals. Even if the referral is permitted, it is still illegal for the physician's financial compensation to be based on the value or volume of such referrals.

Contact Us First

For guidance regarding Medicare and Medicaid fraud, call The Law Firm of Jacobson & Rooks, LLC, at 856-208-5748 or contact us online.