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Attention Health Care Industry Employees:
You may be entitled to Millions of Dollars for Reporting Fraud
at your workplace. If your employer failed to offer state medicaid
agencies the best price on pharmaceuticals, you may be entitled
to a large cash award. Additionally knowledge of other systematic
health care fraud may entitle you to collect substantial whistleblower
awards.
Under Federal law a person who brings fraud
to the attention of the government is entitled to a share of
the amount returned to the government. In March 2005, Dr Steven
Bander who reported systematic fraud at Gambro Health Care, will
personally collect $56 Million Dollars for blowing the whistle
at these Kidney Dialysis clinics. The government has already
paid hundreds of other individuals over $500 Million dollars
nationwide.
If you are aware of a fraud contact us
confidentially online or call 1-800-942-2056
to discuss the situation with our attorneys who can guide you
through the process.
Medicare and Medicaid Fraud is widespread and costs taxpayers
and patients over a billion dollars a year. If your job involves
fraud we can help. Some common situations are listed here.
Pharmaceutical Company Fraud:
Type of Fraud: Medicaid "Best Price" Rule.
Pharmaceutical companies are required by law to give State Medicaid
Programs the best price on drugs. But pharmaceutical companies
sometimes inflate and misreport best prices, forcing Medicaid
Programs to pay too much. People who report this type of fraud
may receive up to thirty percent of the money recovered. These
types of fraud are easy to commit because very often all the
calculations are done in-house by the pharmaceutical companies,
with no oversight.
Potential Whistleblowers: Include current or former drug company employees
doing the "Best Price" determinations or the volume
of sales to each state per each medication; IT personnel who
track erroneous state invoices; and the middle men used to hide
best prices sales; as well as any financial supervisors with
knowledge of the practices.
Type of Fraud: Anti-Kickback violations, used to induce the
use of products.
Inflated Average Wholesale Price (AWP) determinations.
Potential Whistleblowers: Current or former employees usually salespersons
dealing with physicians, event stipend planners and marketing
personnel.
Type of Fraud: Government Contract Violations by Vendors.
Potential Whistleblowers: Current or former employees including fiscal and
audit staff for contract compliance performance, and governemnt
liaison supervisors.
Hospital Frauds:
Type of Fraud: DRG up coding, Usually by switching primary
illness codes.
Potential Whistleblowers: Current or former employees including: DRG coders,
billing personnel, hospitals' charge master revisionists, and
profit center planners.
Type of Fraud: Medically Unnecessary and Shadow Billing or
Outliers
This involves charging Medicaid or Medicare for unneeded
or never performed services. Also involves increasing reimbursement
or qualify more patients as outliers.
Potential Whistleblowers: Current or former employees including: concerned
physicians and nurses.
Type of Fraud: Faculty Practice Plans: Fraudulent Billing/
Inflating Physicians' Fees
How it works: Overbilling of Medicare by mis-labeling private
physicians as employees; billing wrong site of service for hundreds
of doctors; fraudulent Cost Report subsidy of private practice
costs.
Potential Whistleblowers: Current or former employees including: Billing,
preparers of HCFA/CMS Form 1500, Physicians and and administrative
staff; and contract officers handling hospital-physician agreements.
Financial Company Fraud
Type of Fraud: Fraudulent Non-payment of Medicare reimbursement
Potential Whistleblowers: Current or former employees including: insurance
company reimbursement staff.
Insurance Company Fraud
Type of Fraud: Fraudulent Non-payment of eligible Medicaid
HMO Claims
Potential Whistleblowers: Current or former employees including: hospital
accounts receivable staff; and insurance company claims processors.
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