If you’re seeking a healthcare fraud attorney, turn to Kohn, Kohn & Colapinto. With over 30 years of expertise in the False Claims Act and qui tam reward law, our firm has a distinguished track record of unveiling fraud, waste, and abuse within the healthcare industry.

Healthcare fraud is a grave issue, affecting patients, providers, and taxpayers alike. The U.S. Department of Justice recovered over $5.6 billion from healthcare fraud actions in 2021 alone, showcasing the vastness and the pervasive nature of the problem. Much of this recovery has been possible due to whistleblowers who come forward under the False Claims Act.

If you are a whistleblower, having an experienced healthcare fraud attorney at your side is crucial in ensuring you receive the protection and rewards you deserve for reporting your concerns. At Kohn, Kohn & Colapinto, we specialize in representing courageous whistleblowers who seek to expose and challenge fraudulent activities within the healthcare sector. Get in touch today for a free, no-obligation case evaluation.

Types of Healthcare Frauds Covered

Under the False Claims Act, Kohn, Kohn & Colapinto helps whistleblowers challenge various forms of healthcare fraud, including:

  • Upcoding: When providers charge for more expensive services than were actually rendered or separate a group of procedures to increase reimbursement.
  • Kickbacks: When referrals are given in exchange for something of value, violating the Anti-Kickback Statute.
  • Off-label Drug Promotion: When pharma companies market their drugs for uses not approved by regulatory agencies, such as the FDA.
  • Phantom Billing: Billing for medical services not actually provided to patients.
  • Unnecessary Services: Charging for tests, procedures, or devices that aren’t medically necessary.
  • Lack of Medical Necessity: Services provided that aren’t justified from a medical perspective.
  • Substandard or Worthless Services: Charging for medical services that are not rendered as claimed, leading to injury or harm.

Qui Tam & The Whistleblower Reward

Under the qui tam provision of the False Claims Act, private individuals known as “relators” or whistleblowers, can sue a wrongdoer on behalf of the U.S. government – with the help of a healthcare fraud attorney, or on their own. If successful, whistleblowers are entitled to a percentage of the recovered funds.

Whistleblowers can expect to receive:

  • Between 15% to 25% of the proceeds if the government intervenes in the action.
  • Between 25% to 30% if the government doesn’t intervene, and the relator proceeds solo.

Protections for Healthcare Fraud Whistleblowers

At Kohn, Kohn & Colapinto, we understand the risks involved in coming forward. The False Claims Act offers strong protections for whistleblowers:

  1. Anti-Retaliation: Employers are prohibited from firing, demoting, threatening, or harassing employees who act as whistleblowers.
  2. Confidentiality: The identity of the whistleblower can remain sealed and confidential during the early stages of the lawsuit.
  3. Legal Representation: Whistleblowers have the right to be represented by an attorney to guide them through the process and ensure their rights are protected.

Why Choose Kohn, Kohn & Colapinto?

At Kohn, Kohn & Colapinto, we have a track record of successfully representing whistleblowers and ensuring they are both protected and rewarded for their bravery. We are deeply committed to upholding the integrity of the healthcare sector and ensuring taxpayer dollars are rightfully used. If you have information about fraud , waste, or abuse, and are considering blowing the whistle, we invite you to reach out to an experienced healthcare fraud attorney at the firm. We will guide you every step of the way.

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Frequently Asked Questions

Health care fraud involves deceptive practices in the healthcare industry to illicitly gain profits or benefits. This can be perpetrated by patients, providers, or other entities, and common methods include billing for unrendered services, upcoding services to more expensive treatments, performing unnecessary medical procedures, and kickbacks for referrals. These deceptive acts not only lead to financial losses for insurers and consumers but can also compromise patient care and inflate overall healthcare costs.

The Stark Law, formally known as the Physician Self-Referral Law, is a U.S. federal regulation that prohibits physicians from referring Medicare patients for certain designated health services to an entity with which the physician, or a close family member, has a financial relationship, unless an exception applies. The purpose of the law is to prevent conflicts of interest and ensure that physicians’ medical decisions are not influenced by improper financial incentives. Violations of the Stark Law can result in significant financial penalties and exclusion from federal healthcare programs. It is one of the key regulatory mechanisms in the U.S. to prevent healthcare fraud, particularly in situations where there could be overutilization of services due to financial relationships between providers.

Fraud, waste, and abuse (FWA) in healthcare refer to unethical and illegal practices that lead to unnecessary costs to healthcare programs. These activities strain the healthcare system and can lead to compromised patient care and increased healthcare costs. Here’s a breakdown:

  1. Fraud: Intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to themselves or another person. Examples in healthcare include billing for services not rendered, upcoding to more expensive services, and falsifying diagnoses or procedures to increase reimbursements.
  2. Waste: Refers to overuse or extravagant use of services and resources, not caused by criminally negligent actions. It encompasses practices that result in unnecessary costs due to inefficiency or misuse. Examples include overtreatment of patients, mismanagement of resources, or unnecessary tests and procedures that don’t improve patient outcomes.
  3. Abuse: Practices that are inconsistent with sound medical, business, or fiscal practices either directly or indirectly resulting in unnecessary costs, improper payment, or a lack of services. Abuse could be practices that are not necessarily fraudulent but still misrepresent the use of services. Examples include charging excessively for services or supplies, misusing codes on a claim, or excessive referrals.

Addressing FWA is critical for maintaining the integrity of healthcare systems, ensuring patients receive appropriate care, and keeping healthcare costs manageable. Many healthcare organizations and governments have protocols, audits, and investigations in place to detect and prevent FWA.

Our Attorneys

Stephen Kohn

Stephen M. Kohn

Founding Partner
Washington, D.C.

David Colapinto

David K. Colapinto

Founding Partner
Washington, D.C.