Articles Tagged with Medicare fraud lawyer

healthcashThe False Claims Act (“FCA” or “the Act”) is one of the most important tools we have in the fight against health care fraud and other frauds on the federal government. When an organization or individual knowingly takes more money from the government than the law allows or otherwise submits a false claim to the government, the FCA allows the government to recover triple damages plus an appropriate penalty. Examples of false claims include overcharging Medicare for medical treatment and supplying the military with goods that don’t meet contractual requirements. The Act has a special qui tam provision that allows individuals to act as whistleblowers and bring claims on the government’s behalf, a critical tool because fraud is difficult to uncover without help. Although the law provides whistleblowers with a substantial reward for their time and effort if their case leads to a recovery via either a settlement or judgment, most whistleblowers are motivated by a desire to do the right thing and our government fraud law firm is proud to help them.

Recently, we’ve looked back on the success of the FCA in 2015. Today, we look ahead at what 2016 may hold in the health care fraud arena, the sector responsible for the largest share of FCA recoveries in 2015. Becker’s Hospital Review, a leading journal for the health care industry, identifies the following five trends expected to fuel FCA recoveries in the coming year[1]:

  1. Extrapolation – Extrapolation involves examining a sample of payment claims and applying the information learned to all similar claims filed by the same organization. This is a useful shortcut in cases alleging large-scale fraud. Defendants have contested (and will likely to continue to fight) the use of extrapolation claiming it unfairly lowers the government’s burden of proof, but courts have largely ruled in the government’s favor.

Among the lessons we’ve learned as a Medicare fraud law firm is that fraud doesn’t always look like you think it does or involve the type of services you’d typically expect.  Most people would presume a case of Medicare fraud would involve a geriatric doctor, senior care facility, provider of age-related medical devices, or maybe a general practitioner.  However, as the case discussed below reminds us, Medicare fraud extends into every facet of the health care industry.  It is only with the help of honest whistleblowers that we can hope to tame this growing beast.

Indictment Filed in Medicare Fraud Case Against Florida Ophthalmologist

eyedocIn April, the Justice Department announced the filing of a seventy-six count indictment charging South Florida Doctor Salamon Melgen with assorted counts tied to his alleged participation in a Medicare fraud scheme.  The charges include 46 counts of health care fraud, 19 counts involving filing false claims, and 11 counts of making false statements involving health care.  From January 2008 through December 2013, Melgen billed Medicare for more than $190 million and his practice received reimbursements in excess of $105 million.  Officials believe much of this money was received as the result of fraudulent actions.