hush-naidoo-382152-copy-300x200With the development of big data and predictive analytics, it is easier today than ever before to detect and prevent healthcare fraud. Gone are the days of lengthy, old-fashioned investigation, and here to stay are new technologies that can identify fraudulent activities automatically and instantly. By parsing through big data and analyzing payment trends, predictive analytics softwares can identify inconsistencies in payment and seemingly fraudulent activity. This article delves deeper into the system that mines data and predicts fraud by explaining the many components that make up a fraud detection software. If you are interested in learning more about how you can use technology to detect healthcare fraud, contact our attorneys today to learn more.

Link Analysis

Link analysis focuses on measuring relationships. It mines and analyzes data relating to how individuals, healthcare providers, healthcare employees, and healthcare suppliers are related to and interact with one another. It can identify unusual interactions and even unusual identities, such as multiple or fake addresses and phone numbers.

markus-spiske-666905-unsplash-copy-300x200With about one-third of the cost of the healthcare industry in the U.S. lost to fraud, waste, and abuse, it is vitally important to society that we report healthcare fraud when we see it. While it is certainly helpful to familiarize yourself with the most common healthcare fraud schemes and pay close attention to all bills received from your healthcare provider, it is not always easy – or possible – to detect healthcare fraud with the naked eye. Thanks to technology and the development of big data, however, there are new and improved ways to detect healthcare fraud today that have never before existed. Below is a brief overview of how you can use big data to help combat healthcare fraud. If you believe you have witnessed healthcare fraud, contact one of our attorneys today to find out how you can report your claim and initiate a whistleblower lawsuit.

Common Types of Healthcare Fraud

The most common type of healthcare fraud is fraudulent billing. Healthcare providers may bill for services that were never rendered, or bill for a more expensive service than the one that was rendered. For example, a doctor might bill a patient for a two-hour visit when in fact the visit was only one hour long. Fraudulent billing in the medical space is so common that it accounts for up to 10% of annual healthcare costs in the U.S.

benjamin-child-90768-300x200The majority of U.S. states have their own version of the federal False Claims Act (FCA), and California is no exception. Anyone who engages in fraudulent activity in California may be subject to punishment under the California False Claims Act (CFCA). While the FCA and CFCA have many similarities, they have a few differences, as well, which are outlined below. If you believe your employer or another corporation is engaging in fraudulent acts, contact the whistleblower lawyers at Willoughby Brod today to learn about your options for reporting the fraud and how we can help.

Similarities Between the FCA and the CFCA

The FCA and CFCA have many similar provisions, including the following key provisions:

david-everett-strickler-196946-copy-300x195The government only chooses to intervene in whistleblower cases that it finds to be strong and in which it has an interest. By presenting your qui tam case in a strategic way, you can catch the eye of the government and encourage them to intervene. Below are several practical tips for strengthening your qui tam case and increasing your chances of getting the government involved in your case.

Gather Compelling Evidence

The most important thing the government is going to look for in your qui tam case is whether you have compelling evidence. A mere allegation alone means nothing if it is not also accompanied by hard evidence of the fraud you are alleging was committed.

israel-palacio-463979-copy-300x200While most individuals have the opportunity to bring a qui tam whistleblower suit for any violation of the False Claims Act, there are certain exceptions to who may bring a qui tam whistleblower suit and the conditions of the suit. The following are five instances that, if applicable to you, bar you from filing a qui tam whistleblower suit. If you believe any of the following may apply to you, contact an experienced qui tam whistleblower attorney immediately to find out if you fall into one of the below classes and what options are available to you.

Former and Present Members of the Armed Forces

Under the Civil Actions for False Claims Act, a former or present member of the armed forces may not, in his or her capacity as a qui tam whistleblower, sue another member of the armed forces for fraudulent actions arising out of the whistleblower’s service. Additionally, while the statute does not bar governmental employees from bringing a False Claims Act (FCA) suit, governmental employees wishing to bring an FCA suit should be prepared to respond to challenges that he or she cannot bring suit as a governmental employee.

benjamin-child-17946-copy-300x200You blew the whistle on your employer’s illegal actions, and now your employer is retaliating against you. This is not an unusual situation, but it is an illegal one. Both federal law and California law protect whistleblower employees from employer retaliation and impose large fines on employers who choose to ignore this law. If you have been retaliated against at work for whistleblowing, you may be wondering what you can do to remedy this situation. Contact the attorneys at Willoughby Brod today to have your case reviewed for free and receive actionable next steps for what you can do in this situation.

Make Sure Your Whistleblower Actions are Protected in California

California offers general whistleblower protections that protect whistleblowers from being retaliated against by their employers for disclosing or refusing to participate in suspected illegal activities, but it also offers whistleblower protections in the following specific circumstances:

ken-treloar-385255-copy-300x200Medi-Cal fraud occurs more frequently than you think and often goes unnoticed. Unfortunately, this only harms recipients and future recipients of Medi-Cal who desperately need this healthcare assistance program in order to obtain the medical treatments they require. As a whistleblower, you have the opportunity to help put an end to Medi-Cal fraud by reporting healthcare providers and professionals who engage in fraudulent acts. If you detect any fraudulent acts by your healthcare provider, contact the healthcare fraud attorneys at Willoughby Brod today to learn more about how you should proceed with your whistleblower claim.

What is Medi-Cal?

Medi-Cal is a California Medicaid program for low income adults and children that is supported by both federal and state taxes. Those who qualify for Medi-Cal can receive free or low-cost healthcare services and generally receive the same benefits offered under Covered California but at much discounted or free prices. Anyone can apply for Medi-Cal regardless of age, sex, race, religion, sexual orientation, color, national origin, marital status, disability, or veteran status.

samson-duborg-rankin-91091-unsplash-copy-300x200One of the biggest fears many employees have when deciding whether to blow the whistle on their employer’s illegal conduct is employer retaliation. No one wants to rat out an employer when it means he or she will be fired from a job. Luckily, California has whistleblower protection laws in place that make it illegal for employers to retaliate against their employees for being a whistleblower. However, these laws do not always stop employers from retaliating against their employees, especially in more subtle ways. Rather than firing a whistleblower employee, which is obvious employer retaliation, an employer may try to push an employee out in more subtle ways. If you believe you may have been the subject of employer retaliation after blowing the whistle on your employer’s illegal conduct, contact the whistleblower lawyers at Willoughby Brod today to find out how we can help.

Six Ways Your Employer May Try to Retaliate Against You

While pushing you out of the company in more subtle ways, your employer may try to convince you that what they are doing is not considered employer retaliation at all. By making yourself knowledgeable about some of the most common ways employers try to push employees out, you can better equip yourself to recognize employer retaliation when it happens to you.

simon-abrams-286276-copy-300x200No one likes a snitch in petty situations, but in the face of corporate fraud, employee whistleblowers are some of the most invaluable individuals to society. While employees may try to seek recourse for improper employer actions internally, they will often find this path closed off to them. A company’s internal human resources department will more often than not side with the employer and not with an employee who is attempting to divulge negative intel about the company. As such, employees are often left with no choice but to blow the whistle on their employer’s unruly conduct through other outlets. Listed below are just a few reasons why employee whistleblowers are so important. If you have reason to believe your employer is engaging in fraud of any sort, contact the experienced whistleblower attorneys at Willoughby Brod LLP today to have your case reviewed for free by a legal professional.

Employee whistleblowers have an insider’s view.

Employees who work closely alongside the mastermind of the fraud typically have a unique, and superior, vantage point into the fraud that is being committed. Not only are they able to detect fraud at the source, but they are sometimes the only person who is aware of the fraud. Thus, it is crucial that employees who detect fraud within their companies report the fraud as quickly as possible. By reporting fraud in a timely fashion, an employee whistleblower can not only prevent damage to potential victims of the fraud, but also ensure a higher likelihood that he or she receives the highest reward possible from the government for reporting the fraud.

israel-palacio-463979-copy-300x200With the high number of TRICARE fraud cases in the United States, it is no wonder that healthcare fraud is the second highest priority of focus for the U.S. Department of Justice. The $2.7 trillion healthcare industry is an enticing target for those wanting to commit healthcare fraud, which is defined as purposefully misrepresenting a medical treatment or product in order to receive a higher benefit. In fact, Humana Military has estimated that 7-10% of the $2.7 trillion industry is fraudulent. If you suspect your doctor is committing TRICARE fraud, call an experienced qui tam lawyer at The Brod Law Firm today to learn more about how you can report your case as a whistleblower.

What is TRICARE?

TRICARE is a federal healthcare program, similar to Medicare, for uniformed service members, retirees, and their families. TRICARE provides comprehensive coverage to its beneficiaries, including general health plans, special programs customized for beneficiaries, prescriptions, and dental plans.