Whistleblowers who report a healthcare fraud provide an invaluable service to our country since the government spends over $600 billion on Medicare yearly. Some of the biggest profit-driven healthcare companies in the United States took advantage of the honor system, defrauding taxpayers for over $40 billion annually. In the last three decades, the False Claims Act’s Program has become the Department of Justice’s (DOJ) most effective tool to fight this kind of misconduct, with recoveries exceeding $15 billion thanks to the over 4,000 whistleblowers who successfully brought their cases to court. To date, the DOJ paid almost$40 billion in total awards.

WHAT IS A HEALTHCARE FRAUD?

Medicare is a federal insurance program that mostly helps senior citizens paying their nursing facility, hospital, and home health care expenses. Medicaid is a federal-state assistance program that helps impoverished and low-income patients cover their medical expenses. The government and the states pay healthcare providers reimbursements for almost all medical supplies and services, from nursing home care to doctor visits, as well as wheelchairs and knee braces. Medicare and Medicaid are the Federal government’s largest and most expensive healthcare programs. They were originally instituted to benefit well-intentioned physicians and nurses who helped elderly and destitute patients. The most unscrupulous companies saw the vulnerabilities in these programs as a true pot of gold from which they could freely borrow all the money they wanted. In truth, they’re just stealing money from people in their direst time of need.

Billing and reimbursement are self-reporting, so any provider ranging from a local clinic or family dentist to large hospital networks and diagnostic testing laboratories may ask for it. The programs reimburse the provider for most services within 30 days, without requiring any proof that the patient actually received the treatment to be submitted. This makes committing Medicare fraud as easy as checking a different box that pays a higher reimbursement amount than they are owed. The programs lack the monitoring capabilities to make sure that every request for payment is legitimate, and even when overbilling is eventually detected, the company has already spent their improperly earned money or simply disappeared altogether.

WHAT ARE THE CONSEQUENCES OF A HEALTHCARE FRAUD?

Healthcare fraud can cause severe damage to patients, including permanent disability and death. It often takes advantage of some of the most vulnerable citizens such as the children, the disabled, and the elderly. Many cases have highlighted dramatic violations of the sanctity of the physician-patient relationship, dishonestly enabling a physician or a healthcare company to financially enrich themselves at the expense of their patients.

As an example of blatantly unethical policies, some hospitals administered a treatment that was less‐effective or even more dangerous than a more medically appropriate alternative, in order to receive a higher reimbursement. In other documented instances, fraudulent practices that saved a clinic several dollars per patient resulted in hundreds of illnesses or death. In 2008, two Nevada endoscopy clinics owned by Derek Desai, M.D. saved $5‐10 per patient by “double‐dipping” syringes back into a single‐use vial of anesthetic. The outrageous practice resulted in 114 patients contracting Hepatitis C and led to multiple deaths. Unfortunately, this is just one example of hundreds, if not thousands of daily instances where remorseless health care providers put profits ahead of patient safety.

HOW CAN WHISTLEBLOWERS FIGHT AGAINST HEALTHCARE FRAUDS?

Malcolm Sparrow, a leading expert on fraud at Harvard University, estimates that this type of fund  siphoning  scam may cost taxpayers as much as $120 billion annually. The Department of Justice regularly relies on doctors and nurses to come forward and act as whistleblowers since all forms of healthcare fraud can be prosecuted under the False Claims Act as. This type of cases has yielded a 15 to 1 return on money devoted to investigating and litigating other illegal misconducts. In May 2009, Attorney General Eric Holder announced the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT). Together with several Strike Forces investigation centers that operate through the country, HEAT has consistently proven to be extraordinarily effective in uncovering large fraud schemes. Between January 2009 and June 2012, the Department of Justice recovered $7.7 billion in cases involving fraud against federal health care programs. The whistleblowers who came forward with the information that resulted in those recoveries received more than $1.5 billion in total rewards.

WHY SHOULD YOU CHOOSE US TO HELP YOU FILE YOUR CLAIM?

In the last decade, we already fought and won dozens of similar battles, and we have the experience and skill required to help you in court. Whistleblowers International’s attorneys and investigators have fought in some of the largest medical fraud cases ever. We have helped many people secure some of the most notable settlements in the history of the United States. Included below is just one example of our past successes concerning healthcare fraud:

• Warner Chilcott PLC – $125 million for helping the government find illegal kickbacks to physicians, as well as submitting fraudulent prior authorizations.

TYPES OF HEALTHCARE FRAUD

There are dozens of types of fraudulent schemes, and many healthcare institutions have been sued for engaging in multiple illegal practices at once. Below is a list of some of the most common types of illegal Medicare scams.