Building a Healthcare Fraud False Claims Act Case

With healthcare fraud, the False Claims Act can work to protect government money involving either Medicare, Medicaid, Tricare, or some other kind of government employee healthcare program. Under all of these programs, you can work with your False Claims Act healthcare fraud lawyer are to file a case under the federal False Claims Act.

If it is a Medicaid state health insurance program being defrauded, state laws allow you to file a False Claims Act case under one or another of the many state’s False Claims Acts. If there are federal claims too it is possible to file that all at once in a consolidated action. This usually comes into play when somebody has knowledge of a nationwide scheme to defraud health care programs. For more information about building a healthcare fraud False Claims Act case, speak with a qualified whistleblower attorney.

Cases Involving Healthcare

There are a lot of particular issues regarding what is allowed under all government health care programs including Medicare. For example, there is the Anti-Kickback statute, a law designed to prevent unfair inducements from affecting medical judgment and referrals within healthcare. The application of the Anti-Kickback Statute, can get technical quickly. However, when there is illegal remuneration designed to induce the use of healthcare that can violate this law and in turn be a violation under the False Claims Act.

Sometimes, healthcare fraud can be a straightforward case involving someone billing more than they should have. When looking at healthcare fraud cases, there is special sensitivity to any fraud someone practices that also compromises the healthcare provided and causes the patient harm. When a False Claims Act case also involves allegations that the practices affect the health of patients, everyone investigating the case tend to be sensitive to that fact too.

In healthcare, the reason the fraud can become pervasive in the first place is that the government’s relationship to the service is removed. The government pays for healthcare, but the government is not the recipient. The recipient of the healthcare is one individual. So, if that service is defective or wrongful, the government may not have a way of determining what was wrong about the service absent the information provided by the whistleblower.

When building healthcare fraud cases as a whistleblower, it is not an issue generally what level of information the government has about the fraud. In other areas, though, that can become an issue. Government contracting is complicated and not every government administration has the opportunity to review every document. Many government contractors stand almost in the shoes of the government, while administering major contracts, so it is not always clear that the government knew what someone might think they would have known in a government contracting case. Government knowledge in and of itself may not prevent pursuing a False Claims Act Case, but it is simpler in the Health Care context when the government is in a different position altogether.

What to Look for in a Prospective Healthcare Fraud Case

Healthcare fraud is not about a doctor or nurse making a mistake—this may be medical malpractice, but that alone is not necessarily a False Claims Act case. To build and pursue healthcare fraud cases requires knowing where the government lost money and how the government was cheated out of money.

It is about a situation in which for example, a service provider, medical device manufacturer, or pharmaceutical company puts business ahead of the care of the patient and bills that way on a systematic basis. It is a systematic kind of action, not an individual medical mistake or issue. It is not about a mistake in judgment by professional, but rather about a system to treat the federal government or a state government’s money unfairly and bill for services or supplied that should not be billed.

Why File a Healthcare Fraud Whistleblower Case Instead of Going to the Press?

There is a public disclosure bar which makes it difficult to collect on a case based on any information that is in the public domain. By building a healthcare fraud False Claims Act case, prior to going public, if indeed going public is something that you may wish to do, you can more easily preserve the case.

The public disclosure bar has been to some degree lessened by amendments to the False Claims Act, but it can complicate a claimant’s ability to collect. Yes, an original source of information does still have standing even when information is publically disclosed. As a practical matter though a whistleblower can go to the press after consulting with counsel as to when that may or may not be appropriate.  It certainly is not appropriate while a case is being investigated under seal. Later after the government has made a determination and the case has become unsealed, it may be an appropriate time and a smart thing to do.

Before you know what your rights are and before you know what is going on, though, it may not make sense to take your allegations to the public.