Types of Cases Involving the False Claims Act

Whistleblower Attorney for Medicare and Medicaid Fraud

Medicare and Medicaid fraud, along with pharmaceutical fraud and defense contractor fraud are the most common cases filed under the False Claims Act. Fraud dealt with under the False Claims Act, also known as Qui Tam, involves cases where the contractor intentionally presents a false claim for payment to the US Government. Contact a whistleblower attorney at Mike Love & Associates if you have information relating the following types of false claims:

Medicare and Medicaid Fraud

Medicare and Medicaid fraud ranges from minor—but intentional—billing errors, to claims for unnecessary procedures and equipment that cost tens-of-thousands of dollars. Examples of Medicaid and Medicare fraud include:

• Unbundling Medicare and Medicaid Services: This involves submitting multiple or erroneous bills in order to obtain a higher reimbursement. Unbundling can allow for “double billing”, where the office charges more than once for the same service, and “up coding”, where the charge is made for a complex procedure when only a simple one was done.
• Phantom Billing: These types of false claims bill for inappropriate or unnecessary procedures, as well as charging for unused equipment and medical supplies. An example of this is when a provider bills for more expensive equipment when, in fact, cheaper equipment is what the patient really received.
• Erroneous Testing: This involves running tests because patient data falls into a certain range, even though a physician did not request the test. It can go as far as billing for unperformed tests.

Defense Contractor Fraud

Defense contractor fraud is a major area of False Claims Act litigation. These cases usually involve a misrepresentation of how records and products meet contract requirements.

• Failure to comply with contract specifications: Intentional use of inferior products, omitting required tests, and lying about quality assurances
• Kickbacks: Use of kickbacks and bribery to obtain government contracts
• Improper costs and billing: False records presented on cost-allocation and contract types, and falsified reports on billable hours and employee information

Pharmaceutical Fraud

As a result of people contacting whistleblower attorneys about pharmaceutical fraud under the False Claims Act, pharmaceutical companies have paid out more than $3 billion to the federal government and individual states.

Whistleblowers in these cases are typically sales representatives, pharmaceutical company employees, doctors, nurses, and hospitals. Circumstances include any case of Medicare or Medicaid fraud where the government loses money.

Practices that involve pharmaceutical fraud include:

• Paying kickbacks to physicians, hospitals or pharmacists to get them to  favor certain drugs
• Marketing products outside of FDA approved standards and misrepresenting data to the FDA
• Inflating prices to get higher payment from Medicare and Medicaid
• Misreporting benchmark prices to overcharge through various drug programs
• Distributing substandard or tainted drugs

Call a Whistleblower Attorney

Qui tam is Latin for “who as well for the king as for himself sues in this matter.” The government created the False Claims Act to persuade ordinary citizens to work with a whistleblower attorney to get compensation from organizations that are stealing from taxpayers.

Mike Love & Associates will work as your whistleblower attorney in complete confidentiality to help you understand if you have a case under the False Claims Act. The government shares compensation with you under this type of litigation, so it is a win for you and for the integrity of government programs like Medicare and Medicaid.