Class Action Blog : Class Action Lawyer & Attorney : Meiselman, Denlea, Packman, Carton & Eberz : Consumer fraud, Personal Injury

The new healthcare law recently passed by Congress and signed by president Obama includes significant changes and expansions of the federal False Claims Act (“FCA”), making it easier for whistleblowers to file a claim and potentially earn millions of dollars helping the government fight healthcare fraud.

In one of its more significant false claims provisions, the healthcare reform law imposes an explicit duty on physicians to return known overpayments to the government within 60 days of discovering an error. Retaining an overpayment beyond that deadline could constitute a false claim. Because the 60-day window is a short one, doctors should analyze their claims on a regular basis.

Moreover, the new healthcare bill states that anti-kickback violations can also give rise to false claims liability. And when it comes to anti-kickback claims, the government is no longer required to prove that a physician or another claimant had a specific intent to violate the law, making it easier for the federal government to prosecute. And because a wide range of activities could be considered kickbacks -- from discounts to referral fees to marketing practices -- medical providers should scrutinize their arrangements with other health care entities.

Most importantly, pursuant to the new healthcare bill, whistleblowers are given more opportunities to help root out fraud and the healthcare bill eliminates the “original source” requirement of the False claims Act. The health reform law now allows whistleblowers to initiate false claims actions based on information already publicly disclosed through state or local administrative reports or proceedings, such as a state Medicaid audit. In other words, a whistleblower no longer has to be the original source of the information to be able to use those additional facts to help build a case. The amendments to the healthcare bill effectively nullified a March 30 Supreme Court decision, Graham County Soil v. U.S., that held the so-called public disclosure bar was intended to limit a whistleblower's ability to use secondhand information to generate false claims cases.

In sum, the health system overhaul includes changes to the federal False Claims Act and other anti-fraud statutes that:

·         Require physicians to return overpayments within 60 days of discovering a payment error;

·         Make it easier for the government to use anti-kickback violations as the basis for a false claims suit;

·         Allow whistleblowers to initiate lawsuits based on certain publicly disclosed information;

·         Permit physicians to self-disclose potential Stark violations; and

·         Allows the Centers for Medicare & Medicaid Services (“CMS”) the discretion to reduce repayment amounts for Stark violations.

If you are aware of Medicaid and/or Medicare fraud being committed against the United States government by a city, doctor, hospital, clinic, pharmacy and/or medical supply company, you may be entitled to a multi-million dollar award. You can help hardworking taxpayers from being cheated -- and earn millions of dollars in the process -- by blowing the whistle on Medicaid and Medicare fraud.

If you know or suspect that Medicaid and/or Medicare fraud is being committed anywhere in the country, please contact us to discuss your legal options.

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When a medical provider in New York State -- a hospital, doctor, clinic, pharmacy or medical supply company -- commits fraud against New York State, everyone pays.  You, as a taxpayer, end up picking up the state's losses through an increase in your state and local taxes.  But individuals who know of fraud being committed against New York State and/or New York City can put a stop to it by becoming whistleblowers.

Under New York State’s (and New York City’s) whistleblower law known as the False Claims Act (“FCA”), a whistleblower can bring a "Qui Tam" lawsuit against companies and individuals that are cheating New York State and/or New York City.   A Qui Tam lawsuit is an action filed by an individual on behalf of the state and/or city under the FCA.

In the face of widespread fraud and in an effort to strengthen New York State’s efforts to fight Medicaid fraud, which is driving up spending and taxes at the state and local levels, Senate Republican Leader Dean Skelos announced the creation of the Senate Republican Task Force on Medicaid Fraud.  “There is no excuse for tolerating any fraud in a program that is the fastest-growing and largest single component of state and county budgets,” said Senator Skelos.  “Medicaid fraud drives up state spending and taxes as well as local property taxes.  We must fight fraud aggressively, restore accountability and integrity to the Medicaid program, and ensure that tax dollars are spent wisely to help the people who really need help, not enrich criminals who prey on the system.”

“Medicaid fraud is possibly costing New York State taxpayers billions of dollars.  It’s crucial that we act immediately to prevent this type of fraud at the state and local levels,” said Senator Kemp Hannon.  “During a time when every single cent counts, we cannot afford to let the possibility of this amount of money fall through the cracks of the system through fraud and abuse.”

Indeed, whistleblowers are rewarded a significant portion of the proceeds collected on behalf of New York State or New York City.  In fact, whistleblowers are entitled to collect at a minimum 15% to 30% of the total amount of the fraudulent money recovered, and many whistleblowers have collected millions of dollars.

The widespread problem of Medicaid fraud has been highlighted by several reports issued by the state Comptroller’s office that documented millions of dollars in Medicaid overpayments and billing errors. Chemung County Executive Thomas J. Santulli, President of the New York Association of Counties, said, “Recently, New York City and forty-two New York Counties obtained a victory in federal court against 13 pharmaceutical manufacturers for fraudulent pricing through the Medicaid Program. These types of actions continue to demonstrate the relevance and importance of county governments insuring the integrity of the Medicaid Program in New York.” Moreover, in December, the state Comptroller released the results of an audit that identified as much as $92 million in Medicaid overpayments, billing errors and other problems.

If you are aware of Medicaid and/or Medicare fraud being committed against New York State and/or New York city by a doctor, hospital, clinic, pharmacy and/or medical supply company, you may be entitled to a multi-million dollar award.  You can help hardworking New York taxpayers from being cheated -- and earn millions of dollars in the process -- by blowing the whistle on Medicaid and Medicare fraud.

If you know or suspect that Medicaid and/or Medicare fraud is being committed in New York, please contact us to discuss your legal options.

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