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Experienced Mississippi Whistleblower Lawyer Explains Whistleblower Allowed to Proceed with Her Federal False Claims Act Case Against Home Health Agency

The False Claims Act was created to prevent war profiteering against the government during the Civil War. But I want to underscore the word “profiteering” as it applies to anyone who unjustly enriches themselves through a government contract. One area that I have seen a tremendous growth of False Claims Act cases here in Mississippi is health care, specifically regarding nursing homes. It may not be intuitive that fraud involving nursing homes implicates government contracting laws, but the vast majority of home health care is paid for by two government programs, Medicare and Medicaid. As a result, fraudulent activities in the home health setting often end up defrauding the government and make this industry ripe for whistleblower claims under the False Claims Act.

The False Claims Act provides tremendous rewards—15% to 30% of the amount recovered by the government—to whistleblowers. It also protects those who engage in whistleblowing from retaliation such as termination, discipline, or other negative conduct.  Because home health accounts for many millions of dollars in government contracts through Medicare and Medicaid each year, the reward for whistleblowers can be tremendous. Do you know about fraud in the home health care industry? Are you considering filing a whistleblower case? Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Recent Positive Ruling for Home Health Care Whistleblower

On June 11, 2018, The Sixth Circuit Court of Appeals in United States ex rel. Marjorie Prather v Brookdale Senior Living Communities, Inc., et al., for Prather, the False Claims Act whistleblower. I have included a link to the entire case below if you would like to read it.

The Prather ruling is interesting for two reasons. First, it highlights how heavily regulated the home health care industry is. Second, it states that a knowing violation of those regulations can form the basis for a successful whistleblower claim under the False Claims Act.

One of the federal regulations governing home health care services, 42 C.F.R. §424.22(a)(2), states:

“[t]he certification of need for home health services must be obtained at the time the plan of care is established or as soon after that as possible and must be signed and dated by the physician who establishes the plan.”

“home-health agency to complete a physician certification of need after the plan of care is established, but…such a delay [is] acceptable only if the length of the delay is justified by the reasons the home-health agency provides for it.”

In a nutshell, a physician must sign and date a home health care client’s care plan before the company submits the bills for the care to the government, Prather reported to the government that her home health care company was not getting the appropriate signatures before submitting bills. She lost her initial case, and the district court found that her allegations were insufficient to substantiate a claim under the False Claims Act.  The good news is that the 6th Circuit Court of Appeals disagreed, finding that her allegations of regulatory dishonesty created a sufficient basis for a claim. In False Claims Act terminology, the Court of Appeals found sufficient “materiality.”

What Should You Do if You are Considering a Whistleblower Claim?

Are you aware of fraud in the home health care industry? Are you considering filing a whistleblower case? Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Experienced whistleblower lawyer Barrett can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower reward and losing your career and livelihood. Call us today.

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Experienced Mississippi Whistleblower Lawyer Discusses the Perils of Whistleblowing

People often hear of substantial whistleblower settlements and start to dream of what they would do with all of that money. But for every millionaire whistleblower, there are hundreds of people who did not get rich, were retaliated against, and suffered in silence. In the highly technical area of whistleblower law, getting experienced legal advice often means the difference between success and suffering.

A recent case result highlights the sort of challenges many of my Mississippi clients have to endure when they expose government fraud. The whistleblowers were TSA agents who exposed unsafe and sloppy practices. They received a million dollars, or $333,000 each, which will likely catch potential whistleblowers’ attention. But they also endured severe retribution and retaliation at the hands of their supervisors, which should be a warning regarding the challenges of whistleblowing. I provided a link to the press release regarding this case below and will discuss it in some detail.

If you are considering exposing government fraud, contact an experienced whistleblower attorney first. In the end, the federal government will only prosecute very few whistleblowers’ claims each year. Only those that are pursued by the government result in any compensation for the whistleblower, so stating your claim convincingly is critical. I have the experience to help you through the process.  Call me today at (601) 790-1505.

The Whistleblower Protection Act

The Whistleblower Protection Act of 1989, 5 U.S.C. ch. 12 sec. 1201, is a federal law that prohibits retaliation, or threats of retaliation, against federal employee whistleblowers who report misconduct within the federal agency that employs them. Federal employee whistleblowers may file complaints if they reasonably believe that they know of “a violation of law, gross mismanagement, gross waste of funds, abuse of authority, or a substantial and specific danger to public health or safety.” Alleged violations of the Whistleblower Protection Act are prosecuted by attorneys from the U.S. Office of Special Counsel.

T.S.A. Whistleblowers Expose Operations Failures and Safety Issues

In the case resolution announced on May 23, 2018, the Office of Special Prosecutions stated that three Transportation Security Administration (T.S.A.) whistleblowers would receive a total of one million dollars because they had reported problems regarding lax adherence to safety protocols and poor management. The whistleblowers, three T.S.A. administrators, were all working in Hawaii at the time they raised their concerns, and two of them were originally from Hawaii.  Instead of acting on the reports, T.S.A. senior leadership retaliated against the administrators by permanently relocating their positions to the mainland United States.

The attorney prosecuting the federal government’s case, Special Counsel Henry J. Kerner stated, “I am pleased that we were able to achieve favorable results for the three TSA employees who had their lives thrown into disarray and hope this outcome will encourage others to speak up when they see something that could put the public at risk.” I think Kerner sums of the plight of the whistleblower well, there is a chance that you will be well compensated for your decision to bring government abuses to light, but it would be inappropriate to discuss that compensation without the “disarray” that choice will cause.

What Should You Do if You are Considering a Whistleblower Claim?

Do you know about fraud or other serious misconduct, fraud, waste, or abuse of authority occurring in your federal workplace like the one described above? Are you considering filing a whistleblower case?

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Experienced whistleblower lawyer Barrett can provide you with the advice you will need to file a successful Whistleblower Protection Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgment and losing your career and livelihood. Call us today.

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Experienced Mississippi Whistleblower Lawyer Discusses Troublesome Proposed Changes to the SEC’s Whistleblower Program

The past several years demonstrated that the U.S. Securities and Exchange Commission’s (SEC) whistleblower program is a powerful tool in the government’s effort to curb Wall Street corruption. The key to its effectiveness has been its massive incentive provision—whistleblowers can reap 10% to 30% of the funds that the government recovers, numbers sometimes reaching tens of millions of dollars. Keeping all of this in mind, I am troubled by the SEC’s vote in June to propose changes to its whistleblower program that could significantly reduce whistleblower incentives in significant cases. While the new rules are only proposed for now, not final, they appear to be a troubling attempt to disincentivize Wall Street whistleblowing, an act that will turn the financial markets back into the Wild West, with effects here in Mississippi. I have linked to the notice of the proposed rules below.

If you are considering exposing financial or any other type of fraud, contact an experienced whistleblower attorney first. The SEC and Department of Justice prosecute very few whistleblowers’ fraud claims, and only those that are prosecuted result in any compensation for the whistleblower, so positioning your claim effectively is critical. I have the experience to help you through the process.  Call me today at (601) 790-1505.

The SEC’s Current Rules

Since the SEC made its first payout in 2012, the agency has paid out $160 million to 46 whistleblowers.  This past March 2018, the SEC awarded three whistleblowers $83 million as an award for their tips regarding fraud at Bank of America. Currently, these large awards to whistleblowers are merely a function of math, meaning that if you tip the SEC off to $100 million in fraud, you recover 10% to 30% or $10 to $30 million.

The SEC’s Proposed Rules

Under the SEC’s proposed rules, massive awards—rewards for tremendous personal risk—would be discretionary. While the proposed rules allow for payouts for whistleblowers in cases that are currently too small to qualify for the SEC’s program, this shift is troubling. Remember, whistleblowers often risk their career, friendships, and reputation to expose fraud. While it is a nice gesture to open up the SEC whistleblower program to low dollar value fraud, it often just is not worth the risk to expose minor fraud. On the other hand, the SEC’s very purpose is to police large-scale fraud that affects citizens across the country, so by weakening its award program for the largest-scale fraud, it disincentivizes reporting the most critical financial fraud.

In short, the SEC’s proposed rules incentivizes whistleblowing in low-end cases where the risk is rarely worth it and disincentivizes whistleblowing in cases of massive fraud that affect the most people. This seems backward and should not be adopted as a final rule.

What Should You Do if You are Considering a Whistleblower Claim?

Do you know about fraud occurring in a publicly traded company? Are you considering filing a whistleblower case? The proposed rules discussed above are not currently in effect, and huge bounties are available with insider information regarding fraud in the finance industry. To protect your career, reputation, and family and to attain your fair share of compensation, you will require the help of an experienced whistleblower attorney.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Experienced whistleblower lawyer Barrett can provide you with the advice you will need to file a successful SEC whistleblower program case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgment and losing your career and livelihood. Call us today.

 

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Experienced Mississippi Whistleblower Lawyer Discusses Massive Settlement

As everyone knows, there is a tremendous amount of money to be made in the medical industry. Wherever there is money, there is greed. And wherever there is greed, there is fraud.  The False Claims Act prohibits fraud against federal health care programs like Medicare, Medicaid, or Tricare. Those who become aware of fraud, including fraud related to medical programs, can attain significant rewards for sharing their information with the federal government, and awards can reach well into the tens of millions of dollars.

Are you considering filing a whistleblower case? To protect your career and family and to attain your compensation, you will require the help of an experienced whistleblower attorney. Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

The Federal False Claims Act

The Federal False Claims Act (31 U.S.C. §§ 3729-3733), is a law that penalizes individuals and companies that are convicted of defrauding the government. The False Claims Act was created during the Civil War and signed by President Lincoln to root out companies that were taking financial advantage of the war effort. Present day False Claims Act prosecutions are motivated by the same spirit and intent to ferret out fraud against the government.

Health Care Fraud and Kick-Backs at the Center of this False Claims Act Case

The federal government is the largest provider of healthcare in the United States through federal health care programs like Medicare, Medicaid, or Tricare. As a result, whenever large-scale fraud is discovered within the healthcare industry, it likely triggers the False Claims Act, as the fraud will implicate some federal medical program. One aspect of the False Claims Act is a prohibition on kickbacks, which is a financial inducement for a medical provider to prescribe certain medications, refer patients to certain providers, or refer patients for unnecessary procedures. Kickbacks are fraud because they encourage doctors to make decisions based on financial gain and not patients’ best interests.

Medical providers offer physicians a wide array of kickbacks, such as sporting events or concert tickets, phony research grants, free samples that the doctor can in turn sell, payment for participation in phony drug trials, golf outings, free lunches to medical office staffs, and paying for physicians and their families to attend conferences.

The fraud in kickbacks comes into play because doctors are incentivized to send patients for more expensive or unnecessary treatment when a cheaper or more effective alternative was available.  This expense is eventually passed on to taxpayers. Accordingly, the federal government and the Department of Justice, who prosecutes these cases, has a strong interest in rooting out kickback schemes. To make this enterprise more efficient, the federal government provides whistleblowers who alert the government to medical care fraud 10% to 30% of all money recovered as part of the prosecution. This recovery can be modest but can also be in the tens of millions of dollars.

What Should You Do if You are Considering a Whistleblower Claim?

Do you know about fraud or other serious financial misconduct occurring in a healthcare context? Are you considering filing a whistleblower case? To protect your career and family and to attain your fair share of compensation, you will require the help of an experienced whistleblower attorney.

Call Barrett Law now at (601) 790-1505 if you are considering becoming a whistleblower.

Experienced Mississippi Whistleblower Lawyer Barrett can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgment and losing your career and livelihood. Call us today.

 

 

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Experienced Mississippi Whistleblower Lawyer Explains How the Recent Digital Reality Supreme Court Case

Without a rich bounty program for whistleblowers and robust legal prohibitions against retaliation, it is unlikely that anyone would take the risks of reporting fraud—luckily, most whistleblower programs offer both. Clients here in Mississippi often ask me to walk them through a whistleblower claim, a process that usually begins with a description the definition of a whistleblower.

The United States Supreme Court issued a decision, Digital Reality v. Paul Somers, in February that has a dramatic effect on who qualifies as a whistleblower for the purposes of the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2010. I have discussed Dodd-Frank on this blog before; it is a law passed in the wake of the 2008 financial crisis aimed at reforming the finance industry. Interested in incentivizing whistleblowing Wall Street insiders, it offers a 10% to 30% reward to whistleblowers who report fraud and broad protections against retaliation.

The issue in Digital Reality was similar to questions many of my clients bring to me, specifically, “do I qualify as a whistleblower?” Paul Somers, the plaintiff in the case, alerted his supervisors to financial fraud and was subsequently fired. Normally, this sort of clear retaliation would be prohibited against whistleblowers. The question was whether Somers qualified as a whistleblower under Dodd-Frank.

Which Definition of “Whistleblower” Applies Under Dodd-Frank?

Dodd-Frank prohibits “retaliation based on the whistleblower’s attempts to report her concerns.”  Somers’ report to his supervisors would seem to fall neatly under this provision. However, Dodd-Frank goes on to state, that the prohibition against retaliation only applies to whistleblowers who:

  1. Provide information to the SEC,
  2. Who assist or testify in SEC investigations, and
  3. Who report (even internally) suspected violations of securities laws or regulations.

Even when the definition of “whistleblower” is further narrowed by the three categories above, it still seems like Somers’ internal report of suspected violations of securities laws should have satisfied category three.

Remember what I said earlier, that Dodd-Frank has two important parts, one pertaining to the reward program and the other pertaining to retaliation. Somers’ actions seem to meet the definition of a “whistleblower” in the above retaliation section. However, in the reward section of Dodd-Frank, the term is defined much more narrowly. Instead of three different ways to qualify as a whistleblower, it only has one.  This narrow definition states that a whistleblower is a person who provides information to the SEC regarding a securities fraud violation. Somers never did that.

The question before the Supreme Court in the Digital Reality case was which definition of whistleblower should apply—the three-pronged version or the single-pronged one. The court found that the narrowest definition applied, and because Paul Somers did not report his suspicions of fraud to the SEC, he could not enjoy Dodd-Frank’s protections from retaliation.

Dangerous Precedent for All

The Digital Reality decision is bad for whistleblowers, bad for the finance industry, and bad for the SEC.  The decision is clear—if you want a considerable reward, you must report fraud to the SEC, and if you do anything less, you will not have any retaliation protection. For the finance industry, this decision means that employees will now be incentivized to go the SEC to attain protections against retaliation, and the decision creates a disincentive to try to report and fix problems within a company before reporting problems externally. Because the SEC lacks the capacity to investigate every tip it gets, this decision means that a tremendous amount of fraud will go unregulated. In the end, the purpose of Dodd-Frank was to incentivize fraud whistleblowing—Mr. Somers should not be penalized for doing just that.

What Should You Do if You are Considering a Whistleblower Claim?

Do you know about fraud in the finance industry? Are you considering filing a whistleblower case?

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Experienced Mississippi Whistleblower Lawyer Barrett can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower reward and losing your career and livelihood. Call us today.

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Experienced Mississippi Whistleblower Lawyer Explains How HIPAA Affects Healthcare Industry Whistleblower Claims

Many of the whistleblower claims I see here in Mississippi involve the healthcare industry, especially referrals for unnecessary procedures and kickbacks for client referrals. Exposing this sort of fraud can be worth it to the whistleblower, but a question often arises, “how do you expose fraud involving medical patients without simultaneously violating HIPAA?” In simpler terms, how do you show that your employer defrauded a patient without violating their right to privacy regarding their medical records? Luckily, with the help of an experienced whistleblower attorney, you can find “safe harbors” in HIPAA that allow for some disclosure of patients’ records, so long as the disclosure is limited and only occurs in an effort to report fraud.

The Federal False Claims Act

The claim in this $111 million recover was brought under the Federal False Claims Act (31 U.S.C. §§ 3729-3733), a law that penalizes individuals and companies that are convicted of defrauding the government. The False Claims Act created during the Civil War and signed by Lincoln to root out companies that were taking financial advantage of the war effort.

HIPAA

Most people here know it as “HIPAA” and not it’s full name, the Health Insurance Portability and Accountability Act of 1996. HIPAA is a privacy law for entities that handle patient’s medical information, generally prohibiting using “protected health information” such as bills, medical files, or notes for anything other than treatment. Protected health information cannot be shared publicly. This is a problem in whistleblower cases, as the whistleblower often wants to use patients’ files or bills as evidence of fraud. Whistleblowers cannot move forward with a case on general allegations, specific instances of fraud must be provided, often with evidence. But patients’ bills and files normally cannot leave a medical institution and should not be shared publicly. So how does a whistleblower prove their case?

HIPAA’s “Safe Harbors”

In law, a “safe harbor” is a term describing an act that would normally violate the law but is instead allowed because of some higher purpose being achieved. Under federal regulation 45 C.F.R. sec. 164.502(j) linked below, a person may release protected health information if the person believes that his or her employer “has engaged in conduct that is unlawful or otherwise violates professional or clinical standards” or “that the care, services, or conditions . . . potentially [endanger] one or more patients, workers, or the public.” Thus, HIPAA protected health information may be shared in a False Claims Act case by an employee who believes that his or her employer is engaging in fraud.

HIPAA establishes another safe harbor at 45 C.F.R. sec. 164.514(a) & (b), also linked below, for releases of protected health information that is de-identified. To use this safe harbor, an employee must de-identify the protected health information in a way that blacks our or redacts any identifying information. This is not just names and addresses, but also information such as dates of discharge that could be used to deduce the patient’s identity.

What Should You Do if You are Considering a Whistleblower Claim?

Do you know about fraud or other serious financial misconduct occurring in a health care context like the one described above? Are you considering filing a whistleblower case? The handling of protected health information under HIPAA is only one complexity to being a healthcare industry whistleblower.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Experienced Mississippi Whistleblower Lawyer Jonathan Barrett can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgment and losing your career and livelihood. Call us today.

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Experienced Mississippi Whistleblower Lawyer Discusses Massive Settlement Matter

Clients here in Mississippi often ask whether it is worth it financially to be a whistleblower. There certainly are risks involved, but in return for taking the substantial risks sometimes required to expose fraud, the whistleblower may receive a significant percentage of any funds the government recovers.  In May, the government recovered $111 million in a whistleblower case and the four individuals who bravely exposed that fraud are entitled to up to a third of that amount. Because of the significant size of this recovery, I am going to use it as an example in the following blog post.

The Federal False Claims Act

The claim in this $111 million recover was brought under the Federal False Claims Act (31 U.S.C. §§ 3729-3733), a law that penalizes individuals and companies that are convicted of defrauding the government. The False Claims Act created during the Civil War and signed by Lincoln to root out companies that were taking financial advantage of the war effort.

Health Care Fraud at the Center of this False Claims Act Case

The health care industry is increasingly at the center of False Claims Act cases, as the government, through programs such as Medicare and Tricare (health programs for low income and military individuals, respectively) are often paying the lion’s share of payments to healthcare companies. That was the case here, as the allegation was that a medical testing lab called Health Diagnostics Laboratory and a consulting company called Blue Wave Healthcare paid a kickback to doctors who sent patients to them for unnecessary testing. A “kickback” occurs when a private party, here a doctor, receives some payment or gift in exchange for steering a client or patient towards another provider. Kickbacks are prohibited under the False Claims Act; that federal law comes into play when the federal government is paying for patient’s care through a program such as Medicare or Tricare. In essence, the kickback defrauds the government by steering a patient towards a certain provider without regard to quality or price. Here, the fraud was made more serious by the fact that the treatments were not even necessary.

Four different whistleblowers brought claims against the companies regarding different illegal practices. This is also a bit unusual, as usually only the “first to file” is entitled to any settlement, not those who bring claims later. However, each whistleblower in this case brought unique claims to the government’s attention. The named plaintiff, or “relator” in whistleblower terms, was Scarlet Lutz, and her story is a good example of how someone can inadvertently become a whistleblower. Ms.Lutz was not looking for fraud and simply ran a billing company associated with the defendants. However, due to an anonymous tip, she became aware of billing practices suggesting that fraud was occurring. Like Ms. Lutz, all of the relators in this matter were external; the other three ran competing testing labs that lost business because they were not paying kickbacks.

What Should You Do if You are Considering a Whistleblower Claim?

Do you know about fraud or other serious financial misconduct occurring in a health care context like the one described above? Are you considering filing a whistleblower case? To protect your career and family and to attain your compensation, you will require the help of an experienced whistleblower attorney.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

The experienced Mississippi Whistleblower Lawyer at Barrett Law can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgment and losing your career and livelihood. Call us today.

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Experienced Mississippi Whistleblower Lawyer Explains: Reporting Medicaid Kickback Fraud

The Department of Justice recently settled over 27 million dollars in Medicaid fraud cases. I’ve attached an article about it at the end this blog post that will likely interest anyone thinking about becoming a whistleblower. One of the most common forms of Medicaid fraud is “kickbacks,” where a medical professional receives added, unrecorded payments for performing specified therapies or for directing patients to a specific colleague. The drug company, medical device distributor, or another doctor usually pays the physician who prescribes the drug or performs the therapy “under the table” for the additional business.

If you have witnessed this sort of illegal kickbacks in your workplace, you may be able to become a “whistleblower” and report this illegal activity in return for a share of whatever funds the government recovers. In return for taking the substantial risks involved with exposing that fraud, the whistleblower may receive a substantial percentage of any funds the government recovers.  Whistleblowers here in Mississippi frequently recover millions of dollars.

The Federal False Claims Act

The Federal False Claims Act (31 U.S.C. §§ 3729-3733) is a law that penalizes individuals and companies that are convicted of defrauding the government. Most of the cases I see here in Mississippi are filed under the False Claims Act.

Kickbacks in the Medicaid World

Physicians who receive kickbacks often rationalize them as simply a thank you for prescribing a treatment or procedure that they would have recommended otherwise. Another form of kickback occurs between physicians. When a patient requires a specific procedure, there are often many physicians that can perform it. If a physician improperly directs patients to a specific physician in return for financial payment, that is also an illegal kickback. A kickback is nothing more than a bribe. While the physician may later rationalize that they would have taken the same action without the kickback he or she was provided, that rationalization does nothing to diminish the illegality of the act.

These kickbacks are often handled very informally. They may be cash payments handed over outside of the medical setting. They may also be non-monetary, such as expensive bottles of wine, golf clubs, or vacation home use. All of this informality makes them hard to track.

If you are an employee in a medical clinic or hospital and witness kickbacks being paid to either steer patients towards certain treatment brands or certain specialists, you may be eligible to make a whistleblower claim. To be a successful whistleblower, you must be the “first to file” your claim, meaning that if another coworker reports the kickbacks before you, you will receive nothing. You can remain anonymous for a short period, but if the federal government decides to prosecute your case, your name will become public. As a result, you should be prepared for significant backlash for your actions. However, retaliation is prohibited under the False Claims Act, and retaliation has its own financial penalties for employers who take negative action against whistleblowers.

What Should You Do if You are Considering a Whistleblower Claim?

Are you witnessing kickbacks in your work environment? Are you considering filing a whistleblower case? To protect your career and family and to attain your compensation, you will require the help of an experienced whistleblower attorney.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Experienced whistleblower lawyer Barrett can provide you with the advice you will need to file a successful False Claims Act case regarding kickbacks. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgment and losing your career and livelihood. Call us today.

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Experienced Mississippi Whistleblower Lawyer Explains: Hospice Care Medicaid Fraud

When people are in their final months of life they often go into hospice care. Hospice care is emotional support and pain management for patients with less than six months to live. The money to pay for hospice care is often paid through Medicare, a federal program.

Hospice is a fraught time for most families. Their loved one is about to die and they are often overwhelmed with the many tasks involved in caring for their loved one, dealing with health-related expenses, and the pain of impending loss. As a result, they do not closely watch expenses. Unfortunately, because of the high cost of medical care, this is a ripe moment for Medicare fraud. Because the patient has usually died by the time any discrepancy arises and the family is in no position to remember precisely what medication was given or therapy performed, it can be challenging to detect over-billing or billing for treatments that never occurred. This difficulty is compounded because the majority of hospice care happens in a patient’s home, where the standard controls present in a hospital environment may not be as robust.

If you have witnessed the sort of Medicaid fraud I described above, you may be able to file a False Claims Act whistleblower claim. The Federal False Claims Act (31 U.S.C. §§ 3729-3733) is a law that penalizes individuals and companies that are convicted of defrauding the government. “Whistleblower” is a general term for a private citizen who wants to alert the government to fraudulent acts committed against the government. In return for taking the substantial risks involved with exposing that fraud, whistleblowers can recover 15% to 30% of whatever funds the federal government recovers, amounts that often reach well into the millions.

Fraud in the Hospice Environment

If you work in hospice, you know that it is medication-intensive. The United States and Mississippi are both suffering from the effects of an opioid epidemic. Given that the pain management aspects of hospice often involve opioids, there is a tremendous opportunity to steal or divert medications and resell them on the black market. Similarly, because the patient will likely die shortly after hospice, it is ripe for overbilling and billing for procedures that were not performed.

If you are contemplating becoming a whistleblower in the hospice context, you will likely need to gather a sizable amount of evidence to support your claim. Especially if you are reporting a medical provider’s practice of overbilling, keeping careful notes regarding what treatment did and did not occur will be vital.

To attain any reward as a whistleblower, you must be the “first to file.” You can remain anonymous for a short period, but if the federal government decides to prosecute your case, your name will become public. As a result, you should be prepared for significant backlash for your actions. However, retaliation is prohibited under the False Claims Act, and retaliation has its own financial penalties for employers who take adverse action against whistleblowers.

What Should You Do if You are Considering a Whistleblower Claim?

Do you have knowledge of fraud or other serious financial misconduct occurring in hospice care? Are you considering filing a whistleblower case? To protect your career and family and to attain your compensation, you will require the help of an experienced whistleblower attorney. Because whistleblower programs receive thousands of tips each year, they can only act on a small percentage. If you are going to risk your career, relationships, and livelihood, you want to make your work count.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Experienced Mississippi Whistleblower Lawyer Jonathan Barrett can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgement and losing your career and livelihood. Call  today.

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Experienced Mississippi Whistleblower Lawyer Provides a False Claims Act Overview

Clients here in Mississippi often come to me with questions about becoming a whistleblower. But what is a whistleblower? “Whistleblower” is a general term for a private citizen who wants to alert the government to fraudulent acts committed against the government. In return for taking the substantial risks involved with exposing that fraud, the whistleblower may receive a significant percentage of any funds the government recovers. Whistleblowers frequently recover millions of dollars, and these significant payments often catch folks’ attention and imagination.

The Federal False Claims Act

The Federal False Claims Act (31 U.S.C. §§ 3729-3733) is a law that penalizes individuals and companies that are convicted of defrauding the government. Most of the cases I see are filed under the False Claims Act. It is not a new law and was created during the Civil War to root out companies that were taking financial advantage of the war effort.

How Does the False Claims Act Work?

A private citizen that becomes of fraud and files a False Claims Act claim is technically called a “relator.” From a layperson’s perspective, a “relator” is the same thing as a “whistleblower.” A relator can bring many types of claims, but the most common are for overcharging the government for goods or services, falsely claiming that the products or services meet certain prescribed specifications, or improperly concealing government overpayments. These claims arise in a wide variety of fields, but are especially prevalent in defense contracting, government construction contracting, health care fraud, and fraudulently attaining government loans.

Once a whistleblower’s claim is filed with the federal government, several factors come into play. To have any hope of receiving a reward, your claim must be the first regarding the fraud in question; a second claim for the same conduct will receive nothing. Second, the facts alleged must describe with accuracy significant fraud against the government. Finally, the allegations must allege a serious financial loss. The federal government receives thousands of False Claims Act allegations every year from would-be whistleblowers, but only acts on a few. Having experienced whistleblower counsel by your side is crucial to make sure that your allegations stand out.

A whistleblower’s allegations are usually filed secretly, under seal. But if the government accepts the allegations for prosecution, the allegations will be unsealed, revealing the whistleblower’s identity. This can be a fraught process, as your associates or employer may now know that you are accusing them of fraud, but every whistleblower should be aware that retaliation is also prohibited under the False Claims Act, and that retaliation carries significant monetary penalties as well.

A successful prosecution results in 15% to 30% of recovered funds going to the whistleblower. Because these cases frequently recover many millions of dollars, that recovery may be tremendous.

What Should You Do if You are Considering a Whistleblower Claim?

Do you know about fraud or other serious financial misconduct occurring in the government context? Are you considering filing a whistleblower case? To protect your career and family and to attain your compensation, you will require the help of an experienced whistleblower attorney. Because whistleblower programs receive thousands of tips each year, they can only act on a small percentage. If you are going to risk your career, relationships, and livelihood, you want to make your work count.

Call Barrett Law now at (601) 790-1505 if you think you may be a whistleblower.

Experienced Mississippi Whistleblower Lawyer Barrett can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower judgment and losing your career and livelihood. Call us today.

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