Dozens Charged for $260 Million in Medicare Fraud

Whistleblower lawyers at Pintas & Mullins Law Firm announce that 90 people have been charged for generating over $260 million worth of false Medicare billings. The fraud was discovered by a federal task force, and among those charged are at least 16 doctors. Our whistleblower attorneys explain this case and detail what you can do to stop Medicare fraud.

The Medicare Fraud Strike Force is a joint effort established in 2007 by the Department of Health and Human Services and the Justice Department. This most recent strike was conducted in Miami, Tampa, and Los Angeles, among other cities.

In Los Angeles, several doctors were arrested for receiving kickbacks – or cash incentives – to refer Medicare patients to companies that sold faulty wheelchairs and other medical equipment. Those charged in Tampa were part of an alleged scheme that defrauded Medicare for $12 million. The Tampa suspects billed Medicare for services at healthcare clinics using names of patients who actually lived near Miami, nearly 300 miles away.

Unfortunately, Medicare and Medicaid fraud is quite common, which is why the government has set up a dedicated task force to help stop it. Individuals, too, are able and very much encouraged to turn in people defrauding the government in any way.

Whistleblowers and Qui Tam Actions

The False Claim Act allows private citizens to sue on behalf of the government when they know that a company or person is defrauding a government spending program, such as Medicare. This is a huge problem for many reasons, most notably because it hurts one of our country’s most vulnerable populations, the elderly.

U.S. Attorney General Eric Holder states that Medicare is a “sacred compact with our nation’s seniors,” and in order to protect it, “we must remain aggressive in combating fraud.” Most nursing home residents rely on Medicare for their health coverage, which they direly need.

An important note to those with loved ones in nursing homes using Medicare: residents in Medicare or Medicaid-certified nursing homes have certain rights and protections under the law. The nursing home must inform residents of these rights and explain them in writing. More information on these rights may be found here.

Lawsuits filed under the False Claims Act are considered “qui tam,” or “whistleblower” actions. On behalf of whistleblowers, attorneys like our team at Pintas & Mullins Law Firm bring qui tam actions involving government fraud, and the government investigates the situation to decide if it will take part in the lawsuit.

Whistleblowers may bring lawsuits when the government has made payments based on false claims, false certifications, or if the government has not been paid money owed to it. The False Claims Act does not apply to situations where the government simply made an unwise decision, and does not apply to cases of mistakes or negligence.

If a whistleblower is aware of blatant fraud and a lawsuit results, that whistleblower is entitled to between 15 and 25% of any money the government gains back. For example, a former employee of a roofing company resigned in 2009 because he believed the company was acting unethically. He worked for the roofing company for over 20 years, and his complaints were never addressed, so he reported his concerns to the federal government.

The former employee knew that the roofing company was offering a lower price to private customers than it was to the government, among other fraudulent price-hiking. The roofing company was also installing defective products in federal buildings.

Last year, the roofing company agreed to a settlement agreement of more than $60 million, for which the whistleblower was entitled nearly 18%. That’s about 10 million dollars. If you or someone close to you is aware or suspicious of fraudulent behavior or schemes to defraud the government, contact our office immediately. We have 30 years of experience working on these types of cases, and provide free, no-obligation, confidential legal consultations to potential client nationwide.

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