Medicare & Medicaid Fraud

Medicare & Medicaid whistleblowers are an essential tool in the fight against fraud in the health care industry. Using whistleblower reward laws like the False Claims Act has proven to be highly effective in combating health care fraud in the United States. Kohn, Kohn & Colapinto (KKC) has represented several whistleblowers in their fight against Medicare and Medicaid fraud.

KKC successfully represented whistleblower Daniel Richardson against his employer, Bristol-Myers Squibb. Richardson filed a qui tam whistleblower lawsuit against the corporation alleging it illegally marketing drugs and, as a result, caused an increase in Medicare and Medicaid costs paid for by taxpayers. KKC represented Mr. Richardson in a qui tam Medicare fraud action against the drug maker and was able to recover $515 million for U.S. taxpayers and the government. Mr. Richardson received a multi-million dollar reward or “relator share” for his contributions serving the public interest.

Medicare whistleblowers are an essential tool in the fight against fraud in the health care industry. Using whistleblower reward laws like the False Claims Act has proven to be highly effective in combating health care fraud in the United States. According to a DOJ press release, in Fiscal Year 2017, $3.7 billion in FCA settlements and judgments were recovered. Whistleblower-initiated cases account for $3.4 billion of the recovered monies, with $392 million in rewards given to whistleblowers. There are now around 600 new whistleblower cases annually.

Experienced qui tam attorneys at Kohn, Kohn & Colapinto have a long history of successfully representing whistleblowers and assisting them in winning rewards.

Violators of the False Claims Act are liable for three times the dollar amount that the fraud they committed against the government as well as civil penalties of $5,000 to $10,000 for each false claim. A qui tam whistleblower can receive between 15 and 30 percent of the total recovery the U.S. gets from the defendant. Merely informing the government about the violation is not enough. You only receive an award if, and after, the government recovers money from the defendant as a result of your suit. Learn more by visiting qui tam frequently asked questions.

Rewards for Medicare and Medicaid fall under the False Claims Act. Those who report False Claims violations are eligible for a reward of between 15 and 30 percent of what the government obtains. This reporting must contain original information leading to successful prosecution, where the government also receives monetary sanctions. In Medicare and Medicaid fraud cases, the person filing the report must work with a whistleblower attorney to file a lawsuit against the violator. Taxpayers have recovered tens of billions of dollars based on medical frauds, including sanctions awarded against drug companies, hospitals, nursing homes, medical providers and doctors.

Below are several types of Medicare or Medicaid frauds:

• Billing Services or Items That Aren’t Necessary
• Billing for Items That Do Not Even Exist
• Unbundling and Upcoding
• Illegal Drug Marketing
• Kickbacks
• Drug Diversion
• Collusion
• Poor Treatment in Nursing Homes

Medicare and Medicaid cases are challenging. The government requires strong evidence if they are to pursue a case. Employees who have worked within the organization they are reporting have the best chances for success. Whistleblowers with inside knowledge of a particular fraud or scheme have an advantage, which increases their chances of receiving an award from the government, provided they strictly follow qui tam case law rules.

Getting the government to pursue a Medicare or Medicaid case requires a substantial amount of evidence. Those who have worked as an employee under the entity they are reporting have the best chances of success, because of their intimate knowledge of a particular fraud scheme. If you know of fraud and can prove the fraud, the government must pay a huge reward, provided you strictly follow the rules governing qui tam cases.

Experienced whistleblower attorneys – At Kohn, Kohn & Colapinto earned the reputation as the premier whistleblower attorneys by winning for whistleblowers for over 30 years.

Leading role in shaping the federal laws that protect and reward whistleblowers. Kohn, Kohn & Colapinto’s dedication to assisting whistleblowers led us to take a leading role in shaping the federal laws that protect and reward Medicare whistleblowers. The partners at Kohn, Kohn & Colapinto work pro bono with Congress to include strong whistleblower protections in reform legislation including the Dodd-Frank Act, the Whistleblower Protection Enhancement Act, the Sarbanes-Oxley Act, the Consumer Product Safety Act, the federal stimulus laws, and the Civil Rights Tax Relief Act. Our attorneys often testify in Congress to defend whistleblowers rights and advocate for effective legislation.

We wrote the book on whistleblower law – The partners at Kohn, Kohn & Colapinto, LLP wrote the leading books on whistleblower law and pioneered the practice area of whistleblower law. Beginning in 1985 with the first legal treatise on whistleblower law, and continuing through 2017, KKC partners have published eight groundbreaking books covering the full range of whistleblower law.