Largest US Government Medicare Fraud Action in History – Qui Tam on the Rise

May 22, 2017

In what was heralded as the largest ever health care fraud enforcement action 412 medical professionals were charged across 41 federal districts, including 115 doctors and nurses. Their various schemes and overbilling of Medicare les to approximately 1.3 Billion Dollars of false claims, which under the False Claims Act could entitle the government to triple damages and nearly 4 billion dollars of recovery.

If this case were the product of a qui tam whistleblower then that individuals or individuals may be entitled to up to 25% of the award due to government intervention, which could be as large as a 1 billion dollar whistleblower award! A billion dollar whistleblower award would also be believed to be the largest in history. Generally, with government intervention in a qui tam matter the relator, also known as the whistleblower would receive from 15-25% of the recovery apportioned to their information. In a case of this magnitude one would suspect if there were multiple cooperators blowing the whistle on this Medicare fraud, the piece of the pie attributable to their information would not be the whole pizza, but even a slice of 1 Billion is tasty, and even if the Medicare fraud gives one indigestion, let’s not forget about the wholesome feeling about doing the right thing which could be the antacid.

The charges involved schemes of billing Medicare, Medicaid, and TRICARE (a health insurance program for members and veterans of the armed forces and their families) for prescription drugs that were medically not needed and the hording of compounded medications that often were not even distributed to beneficiaries.

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A hot button topic for the United States Government is addressing the opioid epidemic. The charges hit hard the medical professionals involved in the unlawful distribution of opioids and other prescription narcotics. An astonishing statistic is that approximately 91 Americans die every day as the result of an opioid related overdose. Statistically, that number has been steadily increasing and is approaching 100 preventable deaths a day or 36,500 a year. Even if you don’t know someone who has been directly affected by the opioid epidemic, as a taxpayer this will indirectly affect you as the government oftentimes subsidizes these drugs and the treatments for them.

The schemes were nationwide and diverse, but all shared the central tenet of overbilling or false billing the government – violations of the False Claims Act (FCA). For example, the owners of an “addiction treatment center” and home for recovering addicts were charged with the submission of over $58 million in fraudulent medical insurance claims for drug treatment services that were allegedly never received. The offense was so brazen that according to the government, the facility recruited drug addicted patients to move to Florida so they could bill for fraudulent treatment and testing, and the clinic offered kickbacks in such as gift cards, free airline trips and trips to casinos and strip clubs, and drugs. There is an anti-kickback statute and kickbacks like this manifest themselves in several ways and may be actionable.

In Michigan, health care workers were charged with their alleged roles in fraud, kickback, money laundering and drug diversion schemes. This included hundreds of millions of false claims for services that were medically unnecessary or never provided. For example, some physicians, were charged with prescribing medically unnecessary substances and billing Medicare over 100 million for injections, testing, and other services and items that were not provided.

Every single act of a False Claim to the Federal government triggers liability. Technically, under the statute the Defendants have 30 days to accept their liability or they may face triple damages and 4 billion is a large ticket to pay. If the government is right about these allegations of health care fraud and extensive Medicare and Medicaid overbilling and fraudulent billing then they’ve unearthed one of the largest culture of corruption. At some point these health care practitioners who took an oath to defend life became callous to right and wrong and the corruption rather than integrity became the norm. What remains to be seen is who if any of these 412 professionals will fight the charges, after all they are innocent until proven guilty or if in the specter of these qui tam arrests whether there will be another wave of arrests and Medicare fraud indictments as the guilty seek to cut deals to lessen their own liability and perhaps gain less time in jail.

One component of qui tam litigation that is often overlooked is the consequences. It’s never too late too act. If you’re immersed in Medicare fraud scheme, you need to look for the exit and consult with a qui tam lawyer or whistle blower law firm to go over your options. Early cooperation may save your liberty and entitle you to an award for blowing the whistle. The longer you are part of the plot to defraud the government, the more your options dwindle, but the door is not entirely shut until the Feds knock on your door like they did last week to these 412 alleged Medicare cheats. Often times Medicare fraud lawyers will offer free, confidential consultations and can talk you through your options, so it doesn’t end quite like this.

Based on the extent of the fraud, there will be more to come regarding this action.