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Health Care Fraud and the False Claims Act

Health Care Fraud and the False Claims Act

Health care fraud costs federal and state governments billions of dollars every year and has contributed to the rise in health care costs. Millions of Americans receive health care through government sponsored plans, including Medicare and Medicaid-the two largest government sponsored plans. The government attempts to collect back fraudulent payments and relies largely on whistleblowers to provide information regarding fraud.

Some examples of heath care fraud include:

  • Billing for services, treatments or supplies that were never provided;
  • Billing for unnecessary medical services;
  • Performing unnecessary services, like diagnostic tests the doctor knows are not needed but performs anyway in order to collect payments from Medicare, Medicaid or other government-sponsored plans;
  • Up-coding, which involves submitting a claim for a service, treatment or test that costs more than the service, treatment or test that was actually provided;
  • Kickbacks, which are payments for the referral of patients or services. Examples of kickbacks include referral fees, finder’s fees, productivity bonuses, discounted leases or equipment rentals and payments from pharmaceutical companies;
  • Unbundling: Government-sponsored plans like Medicare and Medicaid, often have special reimbursement rates for groups of services or procedures that are typically performed together. It is fraudulent to unbundle these group services and bill for them separately in order to receive a higher payment from the government.

Individuals with knowledge of health care fraud can file a qui tam lawsuit on behalf of the government under the False Claims Act. Individuals who do this are called relators because they are relating information to the government. Relators must be represented by an attorney in order to file a qui tam lawsuit. If the government recovers money that was fraudulently paid out, the relator is entitled to between 15-25% of the money recovered. Contact us today if you have knowledge of health care fraud and want to find out if you are eligible to file a qui tam lawsuit.

  • Super Lawyers
  • ABA - Defensing Libery Pursuing Liberty
  • The American Trial Lawyers Association
  • NELA - National Employment Lawyers Association
  • MCBA - Monroe County Bar Association
  • NYSBA
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