jonathan-perez-409943-copy-300x200During this final week of Medicare open enrollment, you may receive multiple calls each day regarding your Medicare coverage. Many of these calls may be scams, and unless you know exactly what to watch out for, these scams can be difficult to spot. Make sure you follow the guidelines below and report any Medicare fraud you detect to the proper agencies. If you believe your employer or healthcare provider is the one committing the fraud, contact the qui tam attorneys at Willoughby Brod to learn how you can report the fraud and receive an award for your tip.

Four Tips for Avoiding Medicare Scams

  1. Do not give out your Medicare number to anyone other than your doctor or someone who should have it.

chris-greenhow-662446-unsplash-copy-300x225While whistleblowers sometimes get a bad rap as “snitches,”the opposite in fact is true. By revealing their employers’ illegal actions, whistleblowers help society in ways that only whistleblowers can. If you have any doubts about whether you should blow the whistle on your employer’s illegal actions, contact the whistleblower attorneys at Willoughby Brod today to learn more about the ways in which whistleblowers help society and the ways in which you can contribute to that cause.

  1. Whistleblowers help citizens save money.

From 1986-2016, recoveries made from whistleblower cases under the False Claims Act alone totaled over $28 billion. That is $28 billion that could have ended up in the hands of fraudsters rather than back in citizens’ pockets. By blowing the whistle on fraudulent acts, whistleblowers not only protect those who are directly harmed by the fraud but also send a message to fraudsters that the actions they wish to engage in are unacceptable and will not go undetected.

jonathan-perez-409943-copy-300x200One of the most common types of healthcare fraud in violation of the False Claims Act (FCA) is pharmaceutical fraud. It is also one of the most highly reported types of healthcare fraud, with over $4.5 billion of financial penalties issued from qui tam lawsuits in 2012 alone. While whistleblowers are important to the healthcare industry in general, it is clear that their contribution to the pharmaceutical sector has been huge. If you suspect that you have witnessed pharmaceutical fraud, contact the qui tam attorneys at Willoughby Brod today to learn more about your options moving forward.

What is Pharmaceutical Fraud?

Pharmaceutical fraud involves illegal actions that pharmaceutical companies engage in that violate the FCA or CFCA and result in false claims to insurers and Medicare/Medicaid. There are several predominant types of pharmaceutical fraud, which are highlighted below.

james-williams-502481-unsplash-copy-300x225There is no such thing as “good” fraud, but on the hierarchy of Medicare fraud from bad to worst, hospice fraud is arguably one of the most despicable types. Medicare Part A covers hospice care for patients who are “terminally ill,” or have a life expectancy of six months or less. If you believe you have witnessed hospice fraud, make it your duty to report the fraud and honor an individual’s last moments in this world. The whistleblower attorneys at Willoughby Brod are experienced at helping whistleblowers bring their claims forward and protecting them in the process. Contact us today for a free consultation and to learn how we can help.

What Does Medicare Provide by Way of Hospice Care?

As mentioned above, Medicare Part A covers hospice care for patients who are deemed by a medical professional to be terminally ill, which is defined as having a life expectancy of six months or less. Medicare covers only hospice care for terminally ill patients and not any curative treatments, although hospice patients can continue to receive curative care coverage for conditions unrelated to the cause of their terminal illness.

rene-bohmer-430927-unsplash-copy-200x300One common concern that holds people back from becoming whistleblowers is the fear that they will face discipline for being involved in the same fraud they are now reporting. Sometimes employees feel coerced by their employer into partaking in fraudulent actions, and other times the employee may have been the one to spearhead the fraud. In both cases, if you have had a change of heart, and not only do you no longer wish to participate in the fraud, but you want to put an end to it altogether, contact the qui tam attorneys at Willoughby Brod today to learn more about what steps you should take next.

When You Participated in the Fraud but Did Not Spearhead it

Both the False Claims Act (FCA) and the California False Claims Act (CFCA) want to afford whistleblowers the maximum protection possible so as not to deter people from coming forth as a whistleblower. Therefore, in most circumstances, a whistleblower who partook in the fraudulent act they are now reporting will not face any penalties for participating in the fraud.

hans-reniers-746177-unsplash-copy-300x200One common category of healthcare fraud schemes in the medical laboratory industry revolves around medically unnecessary testing. There are many different ways in which the medical laboratory industry fraudulently commits medically unnecessary testing, which are highlighted below. If you believe you have witnessed healthcare fraud involving medically unnecessary testing, contact the healthcare fraud attorneys at Willoughby Brod to learn more about what you should do next.

What is Medically Unnecessary Testing?

Medically unnecessary testing occurs when clinical laboratories order tests that are excessive, unnecessary, or inappropriate for a patient’s treatment. Not only can this be extremely costly, it can also be dangerous to a patient’s life.

samuel-zeller-360588-copy-200x300Though similar in purpose, the Anti-Kickback Statute (AKS) and Stark Law have many differences that are often overlooked or ignored by the general public. If you believe you have witnessed a form of healthcare fraud but are unsure whether the fraudulent act was a violation of the AKS or Stark Law, contact one of the experienced AKS and Stark Law attorneys at Willoughby Brod today for your free case review.

What is the Anti-Kickback Statute?

The AKS provides that physicians and hospitals are not permitted to refer patients to other healthcare providers in exchange for something of value, whether in cash or another form. The purpose of this statute is to ensure that referrals are genuine and based on merit rather than based on familial or professional networks.

ken-treloar-385255-copy-300x200Even though the Anti-Kickback Statute is a federal criminal statute that results in serious penalties when violated, it is also one that physicians and healthcare professionals violate on a regular basis. If you believe you were referred to a physician or other healthcare provider as part of a monetary or other valuable exchange, you may have witnessed an Anti-Kickback Law violation. However, there are certain “safe harbors” that protect physician payment plans that would otherwise constitute a violation under the Anti-Kickback Statute. If you are unsure whether your physician’s payment plan falls into one of the safe harbors, contact the attorneys at Willoughby Brod to get your questions answered.

What is the Anti-Kickback Law?

The Anti-Kickback Statute says that physicians and hospitals are not permitted to refer patients to other healthcare providers in exchange for something of value, whether that is cash or something else. The purpose of this statute is to ensure that referrals are genuine and based on merit rather than based on familial or professional networks.

dylan-nolte-576808-unsplash-copy-300x200Whistleblowers are one of the most misunderstood groups of people out there. From an outsider’s perspective, it can be difficult to understand why someone would want to be a whistleblower – and that is the first problem. Whistleblowers hardly ever choose to become whistleblowers. They happen to encounter situations that, in their mind, call for a solution that will promote justice and better society. If any of the myths below resonate with you, read on to find out why it is a myth, and what the truth really is.

Myth #1: Whistleblowers are disloyal.

Oftentimes, whistleblowers are referred to as “snitches” and disloyal employees, but quite the opposite is true. Whistleblowers are oftentimes the most loyal employees at a company.

benjamin-child-90768-300x200Reporting your boss for engaging in unlawful conduct at work not only requires courage but also thick skin. While some will undoubtedly tout you as a hero as soon as you blow the whistle, others may not be as friendly or supportive. You should prepare yourself for the worst, from your employer as well as from the public, should you decide to blow the whistle on your employer. Despite the risks of whistleblowing outlined below, however, remember that you are contributing to justice and ultimately contributing positively to society when you report illegal conduct. If you are unsure, nervous, or scared about how best to proceed, speak with one of the lawyers at Willoughby Brod, and they will be able to help you decide what is best for you.

Employer Retaliation

The biggest risk of whistleblowing is employer retaliation. California law prohibits any form of employer retaliation toward whistleblowers, but many employers try to do it anyway. Many think that if they do it in subtle ways, like slowly pushing the employee out of their role or finding another reason to demote them or decrease their pay, that there will be no consequences to them. From an even less straightforward angle, employers and fellow employees may start to become hostile toward the employee, spreading rumors about the employee, scheduling meetings only when the employee is unavailable, or ignoring the employee in social settings. However, this type of behavior is illegal. If you have been retaliated against by your employer, contact our attorneys immediately so that we can help you fight for your rights.