Medicaid and Medicare Upcoding & Fraud Whistleblower Lawsuits

Medicaid and Medicare Upcoding and Fraud Whistleblower Lawsuits (Upcoding Qui Tam Claims, Mischarging for Services Claims, Double Billing Qui Tam Claims, Illegal Kickback Qui Tam Claims, & Other Medical Service Provider Fraud Claims)

Healthcare fraud costs taxpayers an estimated $100 billion each year. Illegal Kickbacks, Upcoding, Double Billing, False Coding, and fraudulent mischarging of health care services are just a few ways that fraudulent medical providers are able to defraud Medicare, Tricare, the Veterans' Administration (VA), and other government services out of billions of dollars. Heroes including health care administrators, doctors, nurses, and therapists are stepping forward and blowing the whistle on Tricare, the Veterans' Administration (VA), and Medicare billing fraud including manipulation of outlier payments to Medicare, kickbacks, upcoding, or bill padding. If you are a healthcare professional that is aware of fraud, please become a Tricare, Veterans' Administration (VA), Medicaid, or Medicare Whistleblower.

Health Care Fraud Upcoding Whistleblower Law Suits (Medicare, VA, and Tricare Upcoding Qui Tam Whistleblower Claims)

Upcoding occurs when a medical service provider intentionally and fraudulently upcodes services to obtain a higher reimbursement than one that is entitled to for the service that was actually provided. In both the Medicare and Medicaid systems a set of billing codes is used by healthcare providers to bill for services. These codes are known as the Healthcare Common Procedure Coding System (HCPCS). A service provider that intentionally uses a higher paying code to fraudulently reflect that a more expensive procedure or device was involved in the patient’s treatment than actually was used or was necessary. A pattern of intentional upcoding treatment can result in large profits for the healthcare provider, but also cost taxpayers millions of dollars.

Upcoding fraud is typically hard to catch without the help of persons with inside information because that Healthcare Common Procedure Coding System (HCPCS) codes are billed electronically and can easily slip through the system. Therefore unless the upcoding is caught through a random audit (approximately 2% of the claims per year are audited), it is up to insiders, informants, heroes, and health care professionals to catch fraudulent upcoding.

Another type of coding fraud is “unbundling”, where bundled related procedures or composite lab tests are run together, but billed separately by the lab or healthcare provider to obtain more compensation. These types of billing fraud also allow healthcare providers and labs to make higher profits by bilking Medicare, Medicaid, and taxpayers out of millions of dollars. These unbundling fraud schemes are also hard to detect without someone that is familiar with the codes and billing.

Qui Tam Whistleblower Plaintiffs have received over $1 Billion in Awards of the over $12 Billion in Recoveries for Exposing Fraud Against the United States Government (Qui Tam Plaintiff Whistleblower Claims)

Medicaid, Tricare, Veterans Administration, Hospice, and Medicare Whistleblowers that provide original source information of schemes to fraudulently take money from our United States government including upcoding, double billing, bill padding, unbundling, and charging for services never provided may recover a portion of the proceeds recovered on the government's behalf. Since 1986, relators have recovered over $1 billion for helping expose fraud against the United States government.

Below is an excerpt from the False Claims Act explaining what types of awards qui tam whistleblowers may recover for being the "original source" of information that is used to successfully expose fraud against Medicaid, Tricare, Veterans Administration, Hospice, Medicare, or another subdivision of the United States Government and recover money from the parties committing the fraud.

(d) AWARD TO QUI TAM PLAINTIFF

(1) If the Government proceeds with an action brought by a person under subsection (b), such person shall, subject to the second sentence of this paragraph, receive at least 15 percent but not more than 25 percent of the proceeds of the action or settlement of the claim, depending upon the extent to which the person substantially contributed to the prosecution of the action. Where the action is one which the court finds to be based primarily on disclosures of specific information (other than information provided by the person bringing the action) relating to allegations or transactions in a criminal, civil, or administrative hearing, in a congressional, administrative, or Government [General] Accounting Office report, hearing, audit, or investigation, or from the news media, the court may award such sums as it considers appropriate, but in no case more than 10 percent of the proceeds, taking into account the significance of the information and the role of the person bringing the action in advancing the case to litigation. Any payment to a person under the first or second sentence of this paragraph shall be made from the proceeds. Any such person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys’ fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.

(2) If the Government does not proceed with an action under this section, the person bringing the action or settling the claim shall receive an amount which the court decides is reasonable for collecting the civil penalty and damages. The amount shall be not less than 25 percent and not more than 30 percent of the proceeds of the action or settlement and shall be paid out of such proceeds. Such person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys’ fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.

Since amendments were made to the Federal False Claims Act in 1986, citizens that have filed suits on behalf of the federal government against government contractors that have participated in defrauding the government have regained over $12 Billion for taxpayers as well as have collected over $1 Billion in qui tam whistleblower awards.

Government Contractor Fraud Qui Tam Whistleblower Lawsuit Information (False Claims Act Whistleblower Qui Tam Action Information)

For more information on Medicare Fraud, Tricare Fraud, Medicaid Fraud, Defense Contractor Fraud, Off Label Fraud, Road Construction Fraud, and other types of False Claims Act Whistleblower Claims, please go to the Qui Tam, Whistleblower, and Federal Federal False Claims Act Information Center or the following webpage on Medicaid and Medicare Upcoding & Fraud Whistleblower Lawsuits (Upcoding Qui Tam Claims, Mischarging for Services Claims, Double Billing Qui Tam Claims, Illegal Kickback Qui Tam Claims, & Other Medical Service Provider Fraud Claims) .

Texas Birth Injury, Small Child Injury, and Birth Defect Lawsuits

Texas Birth Injury Lawsuits, Texas Primary Pulmonary Hypertension PPH Lawsuits, Texas Infant Traumatic Injury Lawsuits, and Texas Small Child Traumatic Injury Lawsuits (Birth Injury and Birth Defect Lawsuits)

Avoidable birth injuries, birth defects, fatal accidents, and traumatic injuries are some of the most devastating problems that can occur to a parent, family, and/or a small child. Parents and family who should be celebrating the life of their new child, are often caught off guard when their child is taken from them, born with severe disabilities, or suffers significant injuries in an avoidable accident. After a death, accident, or discovery of a birth defect, the family is often busy taking care of the child with the serious health problems or grieving their loss, and often does not have the time or energy to seek compensation from or battle the party or parties that caused the death, birth defect or accident.

Texas Birth Injury Hypoxia Brain Damage Lawsuits
(Causes of Hypoxia During Birth)

Several types of accidents and negligent actions can cause an unborn child to suffer hypoxia resulting in a brain injury during the birthing process including a difficult labor, unreasonable delay in performing a C-section, delay in delivering an extremely large baby, gestational diabetes in the mother, failure to properly and timely resuscitate the baby, maternal or fetal bleeding complications, excessive administration of Pitocin, and placenta previa. It is important during any birth to have medical professionals that are able to protect the safety of the mother and child by not allowing any of these factors to become a problem. If problems arise and these difficulties occur during the birth of your child and the child sustains a brain injury, you may want to contact a Texas Birth Injury Lawyer with the skill and dedication to help you get the compensation.

Texas Medication Birth Defect Lawsuits

Several medications, products, and drugs have been linked to birth defects. Some of these medication and products have ample warnings that warn pregnant women to avoid taking these products while they are pregnant, however, some manufacturers have hidden the real dangers of their product in order to sell more of their product and value profits over healthy babies. For these manufacturers, they may have short term profits, but over the long term they will suffer for the long term birth defects that they have caused.

Selective Serotonin Reuptake Inhibitor Antidepressants (SSRIs)
Birth Defect Claims and PPH and PPHN Lawsuits

Some medications that have been linked to birth defects include Selective Serotonin Reuptake Inhibitor Antidepressants (SSRIs). Women that have taken SSRIs after the 20th week of pregnancy have a 6-fold increased risk of their child developing persistent pulmonary hypertension, a life-threatening lung disorder. Infants with persistent pulmonary hypertension have abnormal blood flow through the heart and lungs and do not get enough oxygen to their bodies and may become very sick or die. The SSRIs antidepressants that have been linked to persistent pulmonary hypertension (PPHN) include Paxil by GlaxoSmithKline, Zoloft marketed by Pfizer; Prozac sold by Eli Lilly; Celexa and Lexapro by Forest Laboratories, Effexor marketed by Wyeth, Luvox by Solvay, and the generic makers of these drugs include Barr Pharmaceuticals, Ranbaxy Labs and Genpharm.

Infants born with PPHN often require mechanical assistance to breath and even worse about 10% to 20% of the infants do not survive even when they receive treatment. The PPHN babies that do survive often experience developmental delays, brain abnormalities and hearing loss, experts say.

Lamictal Birth Defect Claims

Lamictal is a drug used to treat bipolar episodes and the most serious forms of epileptic seizures. Unfortunately, there is now an association between pregnant women taking Lamictal in there first three months of pregnancy and their children being born with a cleft palate or lip.

Cerebral Palsy Medical Negligence Lawsuits, Texas Medical Negligence Lawsuits, and Federal Tort Claims Act Negligence Lawsuits

"Cerebral" refers to the brain and "palsy" to muscle weakness/poor control. Cerebral palsy itself is not progressive, but is a developmental problem that can occur during fetal development, the birthing process, or infancy. Once a child has cerebral palsy, the child will not get worse over time, however, conditions such as muscle spasticity can develop which may get better or worse over time. Although cerebral palsy is not "curable", training and therapy treatments can help improve function.

The term "cerebral palsy" refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination. Even though cerebral palsy affects muscle movement, it isn’t caused by problems in the muscles or nerves. It is caused by abnormalities or damage in parts of the brain that control muscle movements. The majority of children with cerebral palsy are born with it, although it may not be detected until months or years later. The early signs of cerebral palsy usually appear before a child reaches 3 years of age. The most common symptoms are a lack of muscle coordination when performing voluntary movements (ataxia); stiff or tight muscles and exaggerated reflexes (spasticity); walking with one foot or leg dragging; walking on the toes, a crouched gait, or a “scissored” gait; and muscle tone that is either too stiff or too floppy. A small number of children have cerebral palsy as the result of brain damage in the first few months or years of life, brain infections such as bacterial meningitis or viral encephalitis, or head injury from a motor vehicle accident, a fall, or child abuse.

Cerebral Palsy usually occurs during fetal development, but can occur before, during, or shortly after birth; or during infancy. The faulty development or damage to motor areas in the brain disrupts the brain's ability to adequately control movement and posture. Symptoms of Cerebral Palsy can range in severity. Medical mistakes during the labor and delivery process are to blame for thousands of children with Cerebral Palsy. Unfortunately, many parents don't realize that their healthcare provider might be to blame for their child's Cerebral Palsy.

Causes of Serious Brain Injuries and Brain Damage (Traumatic Brain Damage Lawsuits)

Serious brain injuries can occur through traumatic impact to the head caused by an automobile accident, serious fall, falling object, construction accident, accidental gun shot, boating accident, or a vicious attack. Severe trauma to the head can cause the brain to move inside the skull and injure the brain. The skull typically protects the brain from injury, but because the inside of the skull is rough a traumatic event that causes the brain to move or to swell inside the skull can cause the brain to press up against the skull and cause serious brain damage.

Texas Infant Brain Injury, Child Head Injury, and Hypoxia (Medication Interaction, Carbon Monoxide, and Drowning Victim) Lawyer

Brain injuries including Hypoxia can be caused by several factors including a traumatic injury, lack of oxygen, drowning, carbon monoxide poisoning, smoke inhalation, or drug interactions. If you or a loved one have suffered a serious brain injury or brain damage, the most important thing you can do is to find a good medical doctor to assess the injury so you know what you are dealing with and how to best treat the injury.

Federal Tort Medical Malpractice Claims Act, Product Liability, Traumatic Injury, and Texas Medical Negligence Birth Defect Lawsuits

Federal Tort Claims Act Medical Negligence Lawsuits, SSRI Antidepressant PPH Product Liability Lawsuits, Texas Traumatic Injury to an Infant, and Texas Medical Malpractice Birth Defect Lawsuits are some of the most complicated types of cases in the practice of law. For more information on these types of cases, please go to the following webpage on Texas Birth Injury, Texas Small Child Injury Lawsuits, and Texas Birth Defect Lawsuits.

Texas Business Tort Lawsuits, Breach of Contract Lawsuits, & Breach of Fiduciary Duty Lawsuits

Businesses are the driving force of the United States and Texas economies, and employ millions of Americans and Texans. These businesses face many legal and illegal challenges including fierce competition from other businesses that sometimes use unfair business practices as well as dishonest officers, partners, owners, and employees that breach fiduciary duties. From business torts such as fraud, theft of trade secrets, & misrepresentation lawsuits to breach of contract lawsuits, it is important to have a good Texas business litigation lawyer representing your business and protecting your business assets.

Texas Theft of Trade Secrets Lawsuits and Texas Breach of Fiduciary Duty Lawsuits

Officers and employees that wrongfully steal intellectual property including theft of trade secrets, customer lists, patents, and copyrights can be held liable by Texas courts for breach of fiduciary duty, conversion, fraud, and other business torts. As the intellectual property owned by a business becomes more valuable and easier to steal through technology, it is increasingly important for businesses to protect their intellectual property as well as to make an example of officers, business partners, independent contractors, and employees that steal intellectual property.

In moving forward on a Texas Breach of Fiduciary Duty Lawsuit against a former corporate officer or a Texas Theft of Trade Secrets Lawsuit against a former employee and their new company, it is important to have an experienced Texas business litigation lawyer or Texas business tort litigation team that is able to review and prosecute your Texas Theft of Trade Secret Lawsuit, Texas Breach of Fiduciary Duty Lawsuit or other Texas Business Tort Lawsuit.

Texas Negligent Misrepresentation Lawsuits and Texas Fraudulent Misrepresentation Lawsuits

Texas has business tort laws against both fraudulent and negligent misrepresentation that can be brought against businesses and individuals that make false statements that cause significant damages. Under Texas negligent misrepresentation law, a business or individual "who, in the course of his business, profession or employment, or in any transaction in which he has a pecuniary interest, supplies false information for the guidance of others in their business transactions, may be subject to liability for pecuniary loss caused to them by their justifiable reliance upon the information, if he fails to exercise reasonable care or competence in obtaining or communicating the information." described by the Restatement (Second) of Torts Sec. 522. See Federal Land Bank Ass’n of Tyler v. Sloane, 825 S.W.2d 439, 442 (Tex. 1991).

In moving forward on a Texas Fraudulent or Negligent Misrepresentation Lawsuit against a corporation, partnership, limited liability company, professional corporation, individual, or other business, it is important to gather evidence of the misrepresentation and to have an experienced Texas business misrepresentation lawyer or business tort litigation team that is able to review and prosecute your Texas Fraudulent or Negligent Misrepresentation Lawsuit.

Texas Intentional Interference with a Business Contract Lawsuits and
Texas Unfair Business Competition Lawsuits

Unfair business competition actions arise when a business uses unfair business practices to damage another business or put them out of business. Examples of unfair business competition occur when a competing business intentionally steals trade secrets, releases false press releases, uses short term predatory pricing, demands exclusive contracts from suppliers, forces lenders to call in loans, steals business, or spreads false information in the business community to damage another business or put the business out of business. Because of the size of many small business, losing a major contract, having a supplier stop providing supplies, having a lender call in a loans, or one false press release can cause significant damage and even bankruptcy for the small business.

Texas Business Tort Lawsuits, Texas Business Tort Arbitrations, Texas Breach of Contract Lawsuits, Texas Decepetive Trade Practice Act Lawsuits, and Texas Unfair Business Competition Lawsuits

Texas Business Tort Lawsuits and Texas Business Tort Arbitrations are forms of commercial litigation that require specialized knowledge of not only the law, but an understanding of the businesses and parties involved in the commercial litigation. For more information on Texas Theft of Trade Secret Lawsuits, Texas Misrepresentation Lawsuits, Texas Unfair Competition Lawsuits, and other Texas Business Tort or Breach of Contract Lawsuits click on this link.

Texas Truck Accident Investigation Lawyer

Truck Collision Investigation and Commercial Vehicle Accident Investigation Information (Fatal Crash and Catastrophic Injury Accident Investigations)

After a fatal truck accident or serious injury commercial vehicle collision, an efficient and effective investigation can create advantages in the preservation of key evidence and information that can win a large verdict in a law suit or result in an early and large settlement of an insurance claim. For this reason, it is important to have professionals working for you that understand how to investigate a serious accident and preserve key evidence that can prove liability or damages.

Investigation at the Scene of the Accident

Immediately after an accident, the trucking company and their insurance company are typically in route to the accident scene to collect evidence that will help them avoid paying or limit the amount that they pay for any deaths or injuries that were caused by the accident. These individuals will be taking photos and video of key evidence that will help absolve their client of liability as well as attempting to take recorded statements of key witnesses in an attempt to lock in crucial testimony from witnesses.

Even though law enforcement professionals also investigate serious wrecks, their primary purposes at the accident scene is to get people to safety, protect people from other traffic, and to clear the accident scene for traffic to resume to move and flow. Sometimes these law enforcement professionals do an excellent job of accident investigation and can easily determine the cause of the collision or accident. At other times, they do incomplete interviews; accept the story of one or more biased witnesses; are influenced by the trucking company or insurance company's representatives; or are too busy getting the survivors of the collision to safety, clearing the debris & vehicles, dealing with tow truck drivers, and directing traffic to properly investigate the scene of an accident.

If possible, it is typically useful to have your own experienced accident investigator at the scene of the accident to observe the accident scene; take photographs and video of the debris, vehicles, & skid marks; and make a list of all potential witnesses with contact information. Whether this person is a family member, friend, truck accident lawyer, off duty police officer, or other competent person that you can trust, it is often important to have someone that can properly investigate the accident scene as close to the time of the accident as possible. For the experienced accident investigator, it is useful to have working cameras, measuring tape, a reflective vest, business cards, tape recorder, and a note book or device to take names, addresses and other information.

The experienced accident investigator will carefully search for not only obvious skid marks, drop offs, crush damage, and contact points, but also for inconspicuous clues such as damage to all vehicles, damage to guard rails, scuffs, scratches, and dried liquids. Carefully documenting and measuring this crucial evidence can be extremely important in proving liability in a fatal collision or catastrophic injury accident case.

Preserving Accident Wreckage and Electronic "Black Box" Data Recorders (Spoliation of Evidence)

After a fatal automobile accident or catastrophic injury truck wreck, a preservation letter is often needed to make sure that trucking companies and insurance companies do not destroy or get rid of crucial evidence that can prove fault in a truck accident or commercial vehicle collision. This letter/notice should have language regarding spoliation of evidence and instruct the potentially at fault parties to preserve all relevant information concerning the accident.

The trucking companies and truck drivers often try to get their vehicle away from the accident scene as soon as possible and try to repair any damage to the vehicle before a proper investigation can take place. This is because they can often hide evidence of maintenance problems, vehicle defects, and driver error by working on the vehicle after a fatal collision or catastrophic injury accident.

It is also important to be able to examine the passenger vehicle wreckage and all other vehicles that were involved in the accident. Each vehicle can contain key evidence in determining how a fatal wreck or catastrophic injury collision occurred.

The electronic "black box" data recorder is typically a crucial piece of evidence in any commercial vehicle accident. This is because most modern commercial vehicles with a heavy-duty diesel engine are equipped with an Electronic Control Module (ECM)/Engine Control Unit (ECU) that controls and monitors most of an engine's operations. This "diesel engine electronic brain" may contain important accident information such as engine RPMs just prior to the accident, vehicle speed at the time of and just prior to the collision, brake application prior to impact, throttle position, and clutch application. This information can be crucial in determining how the accident occurred and if driver error or maintenance problems were a proximate cause of the collision.

These recorders are not always turned on by trucking companies and truck drivers as many do not want evidence of their driving habits or safety violations prior to a potential accident. The data recorders also can be easily overwritten and crucial information can be lost. It is usually best to obtain the electronic "black box" recorder at the scene of the accident because the mere act of driving the truck to another location can erase the information stored in the recorder. Though it is not always possible to obtain the data recorder at the scene of the accident, it is important to request it and have a record of the request as soon as possible after the accident.

In addition to the black box information in large commercial trucks, most passenger vehicles have a black box data recorder that is typically referred to as the electronic data recorder (EDR). By the year 2012, all vehicles will be required to have an electronic data recorder.

In passenger vehicles the electronic data recorder is typically the airbag control module that is designed to analyze the collision, determine if airbag deployment is needed, and then to deploy the airbags. If the electronic data recorder has additional energy it will record additional information regarding the collision. To retrieve information stored in an electronic data recorder, accident reconstructionists use Crash Data Retrieval (CDR).

Obtaining and Preserving Documents (Spoliation of Evidence)

Like preserving wreckage and data recorders, it is important to make sure that crucial documents are preserved and obtained from all vehicle owners and drivers involved in the collision. Documents including key maintenance records, driver logs, communications with drivers, delivery schedules, driving records, police reports, witness statements, photographs, driver safety training materials, truck owner's and operator's manual, accident investigations, and medical records can all provide crucial information regarding the cause of a truck collision.

Therefore, after a fatal accident or catastrophic injury accident, a preservation letter is often needed to preserve crucial documents that can prove fault in a truck accident or commercial vehicle collision. A letter/notice should have language regarding spoliation of evidence and instruct the potentially at fault parties to preserve all relevant documents and information concerning the accident.

Truck Accident Investigation Lawyer, Catastrophic Injury Accident Investigations, and Fatal Collision Accident Investigations

If you have suffered catastrophic injuries or have had a loved one killed in a truck wreck or other commercial vehicle accident, it is important to make sure that a thorough investigation of the fatal truck accident or catastrophic injury collision is done. It is also typically a good idea to obtain excellent legal representation from an experienced Truck Wreck Investigation Lawyer to protect you or your loved one's rights and to make sure that an investigation as to the cause of the collision is done correctly.

For more information on Interstate Truck Accidents, Fatal Commercial Vehicle Collisions, and other Commercial Vehicle Wrecks, feel free to go to the following web site, Truck Collision and 18 Wheeler Accident Information and Investigation Center.

Medicare Fraud, Tricare Fraud, Hospice Fraud, and other Health Care Fraud Qui Tam Whistleblower Actions

Health Care Fraud Whistleblower Actions (Medicare Fraud Qui Tam Claims, Tricare Fraud Qui Tam Claims, Medicaid Fraud Qui Tam Claims, and other Fraud Law Suits)

Hospital administrators, nursing home administrators, doctors, coders, benefit coordinators, nurses, chief financial officers, and other health care professionals have been stepping up and blowing the whistle on health care fraud that costs taxpayers about $100 billion each year including Medicare fraud, Tricare fraud, Hospice fraud, and other types of fraud. These health care fraud whistleblowers are American Heroes that have knowledge of false and illegal billing practices, and have had the strength & integrity to file Qui Tam Whistleblower Actions. The result of these health care professionals has been recovery of hundreds of millions of dollars that have been stolen from Medicare, Tricare, and Medicaid as well as improvements in preventing future health care fraud which helps all Americans.

Medicare Fraud, Tricare Fraud, Nursing Home Fraud, Hospice Fraud, and other Health Care Fraud in the News (Whistleblowers and Government Agents Strike Back Against Health Care Fraud)

The Department of Justice has been cracking down on Fraud and False Claims including Medicare Fraud, Tricare Fraud, Nursing Home Fraud, Hospice Fraud, and other Health Care Fraud. Below is an update on recent Department of Justice recoveries.

Pfizer to pay record $2.3B penalty over promotions Repeat offender Pfizer paying record $2.3B settlement for illegal drug promotions By Devlin Barrett, Associated Press Writer On Wednesday September 2, 2009, 3:47 pm EDT

"WASHINGTON (AP) -- Federal prosecutors hit Pfizer Inc. with a record-breaking $2.3 billion in fines Wednesday and called the world's largest drug maker a repeating corporate cheat for illegal drug promotions that plied doctors with free golf, massages, and resort junkets."

Announcing the penalty as a warning to all drug manufacturers, Justice Department officials said the overall settlement is the largest ever paid by a drug company for alleged violations of federal drug rules, and the $1.2 billion criminal fine is the largest ever in any U.S. criminal case. The total includes $1 billion in civil penalties and a $100 million criminal forfeiture.

More Than $1 Billion Recovered by Justice Department in Fraud and False Claims in Fiscal Year 2008

WASHINGTON – The United States secured $1.34 billion in settlements and judgments in the fiscal year ending Sept. 30, 2008, pursuing allegations of fraud against the federal government, the Justice Department announced today. This brings total recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, to more than $21 billion.

"Now, more than ever, it is crucial that taxpayer dollars aren't lost to fraud," said Gregory G. Katsas, Assistant Attorney General for the Department’s Civil Division. "The billion dollars collected this year is only part of the story. By rooting out fraud and vigorously pursuing it, the Department, with the help of concerned citizens who report fraud in hotline calls and in qui tam complaints, undoubtedly saves the country many times that amount in aborted schemes and misconduct."

$361.5 million from Merck & Company to resolve allegations that the pharmaceutical manufacturer knowingly failed to pay proper rebates to Medicaid and other government health care programs, and paid kickbacks to health care providers to induce them to prescribe the company’s products. The settlement resulted from two lawsuits brought under the qui tam provisions of the False Claims Act.

Medicare Fraud, Tricare Fraud, Nursing Home Fraud, Hospice Fraud, and other Health Care Fraud in the News (Whistle Blowers and Government Agents Strike Back Against Health Care Fraud)

Health care fraud Whistleblowers, federal agents, and other American heroes have been striking back against Medicare Fraud, Tricare Fraud, Nursing Home Fraud, Hospice Fraud, and other Health Care Fraud. Below are some recent stories in the news regarding health care fraud and qui tam claims.

Dozens Arrested In Medicare Fraud Busts Across US digg Share this on Facebook Huffpost - Dozens Arrested In Medicare Fraud Busts Across US

KELLI KENNEDY | 07/29/09 10:31 PM | AP

"MIAMI — Federal authorities arrested more than 30 suspects, including doctors, and were seeking others in a major Medicare fraud bust Wednesday in New York, Louisiana, Boston and Houston, targeting scams such as "arthritis kits" – expensive braces that many patients never used.

More than 200 agents worked on the $16 million bust that included 12 search warrants at health care businesses and homes across the Houston area, where the bulk of the arrests were made.

Federal authorities say those businesses were giving patients "arthritis kits," which were nothing more than expensive orthotics that included knee and shoulder braces and heating pads. Patients told authorities they were unnecessary and many never even received them. But health care clinic owners billed between $3,000 to $4,000 for each kit.

Houston's other scam involved billing Medicare for thousands of dollars worth of liquid food like Ensure for patients who can't eat solid food. Authorities said clinic owners never distributed the food to patients. In some cases, clinic owners billed patients who were dead when they allegedly received the items.

It's the third major sweep since Attorney General Eric Holder, Health and Human Services Secretary Kathleen Sebelius announced in May they were adding millions of dollars and dozens of agents to combat a problem that costs the U.S. billions each year.

HOSPICE FRAUD NETS MULTIMILLION DOLLAR RECOVERY

"SouthernCare Inc. and its shareholders have agreed to pay the United States a total of $24.7 million to settle allegations that the Birmingham, Ala.-based company submitted false claims to the government for patients treated at its hospice facilities, the Justice Department announced today. SouthernCare operates approximately 99 locations that provide hospice services in 15 states."

“The Medicare hospice benefit is intended to provide compassionate end of life care to terminally ill patients,” said Gregory G. Katsas, Assistant Attorney General of the Civil Division. “This settlement sends a clear message that the Department of Justice will not allow health care providers to take advantage of beneficiaries in their attempts to game the reimbursement system.”

This settlement results from two qui tam suits filed by two former SouthernCare employees on behalf of the United States. The False Claims Act authorizes private parties to file suit against those who defraud the United States and to receive a share of any recovery. The United States will pay $4.9 million to the individuals who filed the actions against SouthernCare.

HEALTH CARE FRAUD CASE NETS RECOVERY OF $1.7 BILLION

HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company) and HCA subsidiaries agreed to pay the United States over $1.7 Billion including $631 million in 2003 for civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs. In 2000, HCA subsidiaries pled guilty to substantial criminal conduct and paid more than $840 million in criminal fines, civil restitution and penalties. HCA will paid an additional $250 million to resolve overpayment claims arising from certain of its cost reporting practices. In total, the government will have recovered $1.7 billion from HCA.

Blowing the Whistle on Those that Commit Fraud Against the United States Government, First to File Provisions of the Federal False Claims Act, and Preserving Relator Rights to Share in Recovery of Funds (Qui Tam Medicare Fraud, Hospice Fraud, Nursing Home Fraud, Tricare Fraud, and other Health Care Fraud Claims)

If you are a Health Care Administrator, Hospital Administrator, Nursing Home Administrator, Doctor, Coder, Benefit Coordinator, Nurse, Chief Financial Officer, or other health care professional that has knowledge and evidence of a Health Care Provider, Hospice Provider, Nursing Home, Hospital, Medical Supply Company, or other health care contractor or subcontractor that is defrauding Tricare, Medicare, or the United States Government out of millions or billions of dollars, it is important to gather evidence of the fraud and blow the whistle on the fraud.

In blowing the whistle on health care fraud, Medicare fraud, Tricare fraud, VA fraud, or other fraud against the government, it is typically best to contact a Medicare Fraud, Tricare Fraud, and Hospice Fraud Qui Tam Whistleblower Claim Lawyer like Jason S. Coomer and the firms that he works with to help investigate the fraud and pull together a disclosure and complaint to file.

For information on this Qui Tam Whistleblower Medicare Fraud, Tricare Fraud, and Hospice Fraud Claims, go to FederalGovernmentContractorFraud.com

Federal False Claims Act Amendments by False Claims Act Whistleblower Lawyer

Qui Tam Federal False Claims Act Whistleblower Lawsuits through the Federal False Claims Act allow whistleblowers to seek compensation on the government's behalf from companies and people that have defrauded taxpayers out of government money. With the sharp increase in Federal Government Spending has come the need to expand the Federal False Claims Act to prevent unethical wrongdoers from making false claims and false certifications to the government in order to steal millions and even billions of dollars from the United States Government.

American Recovery and Reinvestment Act of 2009 (February 2009)

In February 2009, the American Recovery and Reinvestment Act of 2009 was signed into law which includes significant new whistleblower provisions. Section 1553 of the Act prohibits any private employer or state or local government that receives any funds pursuant to the Act from retaliating against an employee who discloses, internally or externally, information that the employee reasonably believes constitutes evidence of one or more of a number of specified improper uses of stimulus funds, including gross mismanagement of an agency contract or grant, gross waste of covered funds, or an abuse of authority related to the implementation or use of covered funds. Section 1553 establishes procedures and damage remedies that are similar in some ways to those with which many employers are familiar under Section 806 of the Sarbanes-Oxley Act ("SOX"), but its whistleblower provisions go beyond the whistleblower protections of SOX in several respects.

Fraud Enforcement and Recovery Act of 2009 (May 2009)

In May 2009, the Fraud Enforcement and Recovery Act of 2009 was signed into law which makes important amendments to the country's most important tool for fighting fraud, the False Claims Act. This new Federal False Claim Act Legislation will protect hundreds of billions spent on government programs from fraud and government waste and expand the ability of whistleblowers to collect compensation.

This Act amends the False Claims Act to: (1) expand liability under such Act for making false or fraudulent claims to the federal government; and (2) apply liability under such Act for presenting a false or fraudulent claim for payment or approval (currently limited to such a claim presented to an officer or employee of the federal government). Requires persons who violate such Act to reimburse the federal government for the costs of a civil action to recover penalties or damages. The Act also modifies and expands provisions of the False Claims Act relating to intervention by the federal government in civil actions for false claims, sharing of information by the Attorney General with a claimant, retaliatory relief, and service upon state or local authorities in sealed cases.

The Act also redefines "claim" to include claims submitted "to a contractor, grantee, or other recipient, if the money or property is to be spent or used on the Government's behalf or to advance a Government program or interest." This language makes explicit the ability of Government and whistleblowers to pursue subcontractors and grantees. This expansion will create potential liability to health care providers and other businesses that contract with government programs including Medicaid and Medicare.

The Act also redefines "obligation" to include "an established duty, whether or not fixed," arising from a variety of relationships, and specifically includes obligations "arising from statute or regulation, or from the retention of any overpayment." This change allows the government and whistleblower to pursue violations of regulatory statutes with penalty provisions as False Claims Act Case and pursue false documents which are "material to an obligation to pay or transmit money...to the Government" regardless of whether a false claim has been submitted. For example, a government contractor who backdates records to support a claim already submitted could be liable under this expansion.

The Act also expand the anti-retaliation provisions from only employees to include "contractors and agents" who "act to stop one or more violations." This expanded protection could extend to contractors in government-funded managed care plans who take action to stop false reporting or illegal denial of service by the plan.

These expansions to the Federal False Claims Act should increase the number of Federal False Claims Act Lawsuits and allow the Federal Government to crack down on fraud and wasteful spending as well as recoup money that has been fraudulently obtained.

The Fraud Enforcement and Recovery Act also expands federal fraud laws to encompass independent mortgage companies, which are not currently covered by antifraud statutes that apply to traditional banks. Such independent mortgage companies originated approximately half of all subprime loans in 2005 and 2006. The bill defines a financial institution that will be covered by the fraud statutes as any business that finances or refinances mortgages. The Act expands the mortgage-related violations that are subject to both criminal and civil punishments. Additionally, the legislation makes it a crime to appraise a property falsely, an effort to prevent the purposeful inflation of home value appraisals that contributed to the housing bubble and the resulting housing crisis.

The Fraud Enforcement and Recovery Act strengthens protections against attempts to defraud the federal government, particularly through the Troubled Asset Relief Program and the economic stimulus package; expands the financial instruments that are covered by the securities fraud statute; and clarifies a money laundering statute. The Act provides $490 billion in spending for investigation and prosecution of mortgage fraud, securities fraud, and fraud cases involving federal economic assistance.

Federal False Claims Act and Qui Tam Lawsuits

For more information on the amended Federal False Claims Act or Qui Tam Federal False Claims Act Whistleblower lawsuits including the text of the amended Federal False Claims Act, please go to the following web page on Federal False Claims Act Amendments by Federal False Claims Act Whistleblower Lawyer, Jason Coomer.

Defense Contractor False Certification Claim Lawsuits

Common Types of Defense Contractor Fraud and False Certifications that Lead to False Claims Act Lawsuits

Defense contractor fraud is a common way that government contractors defraud the United States Government and taxpayers out of large amounts of money. Many whistle blowers have been successful in blowing the whistle on fraudulent defense contractors to reveal fraud schemes that put our troops in danger and steal money from the United States. Under False Claims Act litigation billions of dollars are regained from these fraudulent defense contractors. Some common ways defense contractors cheat the government are False Certification of Product Quality, Product Substitution, Cross Charging, False Certification of Services Provided, Charging for Services or Goods not provided, and Violations of the Truth-in-Negotiations Act ("TINA"), and Improper Cost Allocation.

False Certification of Product Quality commonly occurs after a product has been approved for mass production. The original prototypes of a product are typically created with high quality materials and parts including strong metals, seals, plastics, and components. However, after the original prototypes have been tested and approved, some defense contractors use inferior parts and materials to lower costs that make weapons, ships, vehicles, computers, electronics, and other military goods less reliable, weaker, and more prone to not work when needed. The defense contractor that provides a false certification of a product's quality has committed a false certification that may subject the defense contractor to a False Certification of Product Quality False Claims Act Law Suit.

The Defense of Department often requires its contractors to build weapons systems in accordance with very detailed product specifications because quality and reliability are critical with weapons systems and other military equipment. Failure to comply with these specifications and falsely certifying that these specifications were met can cause death and place our troops in danger. As such it is extremely important that appropriate quality assurance steps are taken in building or producing weapons systems and other military equipment and that a defense contractor's certification of compliance with these specifications can be trusted.

Similar to False Certification of Product Quality Qui Tam Claims are Product Substitution False Claims. These claims occur when a Defense Contractor that is under a government contract that specifies that the defense contractor build products using a certain grade, quality of parts, or materials & parts from American companies, fails to comply with the contract. These Defense Contractors often decide it is more profitable to use or substitute inferior parts or parts not made by American companies. Defense Contractors that use inferior parts or parts not made by American Companies as required by their government contract may be subject to a Product Substitution False Claim Act Law Suit.

Cross-Charging occurs when a Defense Contractor has a fixed-price contract, where the company receives a fixed price for a certain number of weapons no matter how much it costs to produce them and another that is a "cost-plus" contract, where the government pays the company for the cost of making the weapons, plus a percentage of its costs as a profit. In this circumstance the Defense Contractor has an economic incentive to charge the time it spends working on the fixed-price contract (where it gets paid the same no matter how much time it takes) to the cost-plus contract (where it gets paid for its costs plus profit). This may be accomplished by instructing employees to write down on their time cards that they worked on the cost-plus contract when they actually worked on the fixed-price contract. A Defense Contractor that charges fixed price work on a cost-plus contract is creating false claims or false certifications that may subject them to a Cross-Charging False Claims Act Law Suit.

Improper cost allocation false claims are a more subtle version of the cross-charging scheme. In this type of false claim, a defense contractor with government contracts and private commercial contracts fails to spread or allocate their costs fairly among the different jobs. These types of false claims are typically more difficult to detect as the defense contract usually tries to hide the misallocation in indirect costs or bury the misallocations in hard to interpret records. These improper allocation false claims are more common in large contracts where the product has military uses and private uses such as with large aircraft companies. Defense Contractors that deliberately allocate a disproportionate share of indirect or overhead costs to the government for the purpose on increasing there profits may cause themselves to be subject to Improper Allocation False Claims Law Suits, if the correct whistle blower reports the fraud.

When the government wants to purchase highly specialized weapons, military services, or other military equipment, it often is limited to one potential defense contractor because of the specialized need. This limited supply often creates monopoly power in the "sole-source supplier". This creates a problem in making sure that the sole-source supplier does not over charge the government for the good or services that it is supplying to the government. The Truth In Negotiation Act (TINA) requires the Defense Contractor to truthfully disclose all relevant information about its costs to the government in sole-source contract negotiations. Defense Contractors that submit false cost and pricing data to the Defense Department or failure of a sole-source Defense Contractor to provide accurate cost information to intentionally inflate costs to increase profits can cause liability for a violation of the Truth In Negotiation Act and result in a Truth In Negotiation Act Violation False Claims Act Law Suit.

Qui Tam Defense Contractor False Certification Claim Lawsuits, Defense Contractor Fraud Lawsuit Lawyers, and Other Qui Tam Claim Lawsuits

For more information on Qui Tam Claim Lawsuits and Qui Tam False Certification Lawyers, click on the following links: defense contractor false certification claim lawsuits, health care provider claim lawsuits, financial institute claim lawsuits, or other large contractor or subcontractor claim lawsuits.

Unlawful Medicare and Medicaid Referrals Under Stark Statute

In 1989, the United States Congress enacted the Stark statute which made it illegal for physicians to make self-referrals and prevented physicians from referring Medicare or Medicaid patients for certain designated health services to any entity with which the physician has a financial interest. The purpose of this law was to remove economic incentives that may encourage some physicians to make self-referrals or to refer certain designated health services to entities in which the physician has a financial interest, instead of referrals based on a patient's health and well being.

Stark Violation Claims and Stark Violation Lawsuits

Stark violations occur when a physician (as defined by Medicare) unlawfully refers Medicare or Medicaid patients to an entity in which the physician or the physician's immediate family has a financial interest. In these situations the physician is usually making these referrals for the purpose of the physician's own financial gain and is not working in the best interest of their patients. Repeated violations of the Stark Statute can create substantial wealth for self referring doctors and can cost tax payers millions, tens of millions, or even hundreds of millions of dollars. These violations can also be hard to detect by the government and patients. For this reason it is often health care administrators, hospital administrators, benefit coordinators, accountants, and other health care professionals that are able to discover fraudulent referral practices and blow the whistle on the unlawful practice.

Violations of the Stark Statute can result in both criminal and civil penalties for the self referring doctor as well as others benefiting from the fraudulent referral practices. Whistle blowers that properly blow the whistle on these unlawful referrals can not only regain large amounts of money for the United States government, saving tax payers millions of dollars that the physician and/or the entity have taken from the federal government, but the whistle blower can also collect a percentage of this recovery as compensation for bringing a Federal False Claim Act lawsuit that reveals these fraudulent referral practices.

The History and Evolution of the Stark Statute

The Stark Statute is named after California Representative Pete Stark who authored this legislation to prevent fraudulent referral practices that compromised the health of patients, cost the government billions of dollars, and made unethical doctors rich at the expense of patients and taxpayers. Congressman Pete Stark first proposed the Federal physician anti self-referral law in 1988, and what became known as "Stark I" was enacted by the Congress in 1989. At the same time Congress overhauled Medicare's physician payment program and adopted the Resource-Based Relative Value Scale (RBRVS) which is a system used to determine how much money medical providers should be paid by Medicare. The Stark I law initially applied only to clinical laboratory services and became effective with the Medicare fee schedule on January 1, 1992. The Health Care Financing Administration proposed implementing regulations for Stark I in March of 1992, and these rules were finalized on August 14, 1995. They have been codified at 42 C.F.R. 411.350 et seq.

In 1993, Medicare and Medicaid amendments were enacted by Congress that significantly expanded the Stark law to cover a long list of designated health services in addition to clinical lab services. These amendments added the referral prohibition to additional designated health services including: inpatient and outpatient hospital services; physical therapy; occupational therapy; radiology; radiation therapy (services and supplies); durable medical equipment and supplies; parenteral and enteral nutrients (equipment and supplies); prosthetics, orthotics and prosthetic devices and supplies; outpatient prescription drugs; and home health services. These amendments, which became effective January 1, 1995, became known as "Stark II."

Medicare and Medicaid Referral Violation Law Suits
(Qui Tam Law Suits)

Through Whistle Blower Lawsuits, Qui Tam Lawsuits, and other Health Care Fraud Lawsuits, hundreds of billions of dollars have been recovered from individuals and organizations that have committed health care fraud and stolen large amounts of money from the government. For more information on Stark Statute Violations and Medicare or Medicaid Referral Violation Law Suit, please go to the following web page on Medicare and Medicaid Referral Fraud Stark Violation Law Suits.

Texas and Interstate Truck Accident Lawsuits and Insurance Claims

In handling Texas and Interstate Truck Wreck Lawsuits, it is important to realize that multiple insurance companies and risk management departments may be involved in evaluating an automobile accident claim. Both insurance companies and risk management departments have professionals whose jobs are to limit the amount that their insurance company or risk management department pays on any claim regardless of the liability facts or damages. It is therefore important to make sure that victims of a fatal or a catastrophic injury truck wreck are protected from insurance adjusters, risk managers, insurance investigators, and defense lawyers.

Interstate Truck Accident Lawsuits and Insurance Claims

Interstate Trucking Companies are governed by the U.S. Department of Transportation and must carry liability insurance for accidents that their drivers may cause that result in bodily injury or death. These insurance policies make sure that people who are injured or the families of those killed by negligent interstate truck drivers can be compensated up to the policy limits for damages that have been suffered. These damages can include wrongful death damages, medical expenses, physical impairment, pain & suffering, disfigurement, and lost wages. Evidence of these damages is usually required for large recoveries including obtaining policy limits on an interstate truck accident claim.

Texas Truck Accident Lawsuits and Insurance Claims

Texas requires minimum liability coverage for commercial vehicles not regulated by the U.S. Department of Transportation. In handling Texas Commercial Truck Collision Claims, it is important to investigate all known insurance on each automobile, driver, and vehicle owner involved in the collision to maximize the recovery that is made for the injured person or the family of the deceased. In locating insurance and all potential sources of recovery, it is important to review all potential parties that be liable for the accident to determine their insurance and or their ability to pay a large verdict.

Texas and Interstate Truck Accident Lawyer and Information

For more information on Texas Commercial Truck Accident Lawsuits or Interstate Truck Accident Lawsuits, please go to the following Fatal and Serious Injury Truck Collision Web Page.

Military Medical Malpractice Claims and Lawsuits

With the sharp rise in the number of our service personnel in the Army, Air Force, Navy, and Marines that have served the United States in the Iraq War and Afghanistan War has come an increase in the number of veterans and families of military personnel that rely on the military for medical services. At the same time the demand for quality military medical services has increased the budget and ability of the United States government to pay for these services for our country's service personnel and veterans has decreased. These factors have stressed many military hospitals and military medical service professionals to create environments where military medical malpractice is becoming more common.

Military Medical Malpractice Lawsuits & Military Doctor Negligence Claims

As a Texas medical malpractice lawyer Jason Coomer handles Federal medical malpractice lawsuits, Military medical malpractice lawsuits, VA medical malpractice lawsuits, Texas medical malpractice lawsuits, army doctor negligence claims, and federal medical malpractice claims including emergency room errors, post-surgical infections, birth injury, wrongful amputation, unwarranted testing of experimental drugs on patients, and other kinds of inadequate or unethical treatment birth injuries, drug interactions, medication errors, misdiagnoses (failure to diagnose cancer, spine injuries, heart problems or disease), surgical errors (bariatric surgery errors, spine surgery errors, heart surgery errors, simple surgery errors), Cerebral Palsy, Erb’s Palsy, monitoring errors, and errors resulting in hypoxia.

Common Causes of Military Medical Malpractice Lawsuits and Negligent VA, Army, and Navy Doctors

Unfortunately, medical mistakes often happen when military doctors and nurses get too busy, are understaffed by hospital administrators, are under the influence of drugs or alcohol, are not well organized, are under poor hospital administration, or are just not paying attention. As Veterans Administration Hospital, Navy Hospital, Army Hospital, and other Military Hospital medical budgets decrease, healing people becomes more difficult and is less of a priority than saving money sometimes creating cost cutting measures and poor hospital administration policies that cause under supported military doctors, military nurses, and military medical professionals to commit more medical mistakes. Overworked military doctors, residents, and nurses are much more likely to make mistakes than well rested health care professionals.

Medical mistakes also happen more often when no one is watching. It is extremely important when you are in the hospital to have someone that is with you and to help watch out for your well being. This is especially true if you have an allergy to certain types of medicines, are going to be unconscious or under antistesia, or on strong pain killers. In such, situations it is typically a good idea to have a person that you trust to be your health care advocate with a valid HIPPA Authorization, Medical Power of Attorney, and Power of Attorney. Communication with your health care professionals and your health care advocate is also important and can greatly limit medical mistakes.

If you feel you or need a Military medical malpractice lawyer because you or a loved one has been seriously injured by medical negligence or someone close to you has died as a result of medical negligence or a doctor mistake, it is important to investigate the claim and make sure that it does not happen again.

Communication Prevents Many Medical Mistakes

Military Doctors, Army Doctors, Navy Doctors, Air Force Doctors, and Veterans Administration Hospitals typically provide quality medical care, but sometimes mistakes are made. It is always a good idea to have someone that you trust look out after you when you are in the hospital. This person can communicate important information regarding your condition and watch out for you when you are in the hospital. It is important to make sure that you or your medical advocate communicate with health care professionals to limit the mistakes that are made.

However, even with proper communication medical mistakes can be made. If a mistake is made, it is important to report the mistake and if the mistake causes serious injury or death it is important to investigate a potential federal medical malpractice claim and potential lawsuits. This is because medical mistakes that no one knows about will not be noticed and will not result in future better medical care. Medical mistakes that are reported will help other patients and are an essential part of the feedback needed to improve our health care delivery system.

For more information on Military Medical Malpractice Claims and Preventing Military Medical Malpractice, go to the following web page on Military Medical Malpractice Lawsuits or seek an attorney's advice on setting up a health care advocate for loved ones going into a hospital.