Health care fraud costs Americans $80 billion per year according to the FBI. And the cost is rising! The feds can’t lock up the culprits fast enough – if they can even find them. Law enforcement officials in Puerto Rico are trying to make a dent; the Justice Department announced that 75 people were arrested in a sweep targeting Social Security disability fraud.
The Social Security Administration has long warned that the Social Security Disability Insurance program – SSDI – is in trouble. At the current rate of paying benefits, the program will run out of money by 2016. The program was designed to provide a safety net to people unable to work because of disabling injuries or illness. Lately, it has become a victim of widespread health care fraud.
Puerto Rico has become ground zero for the government’s efforts to snuff out health care fraud. On a per capita basis, there are more people “disabled” and unable to work in Puerto Rico than anywhere else in the nation. Many SSDI recipients are falsely collecting benefits thus endangering the entire program.
It’s impossible to qualify for disability benefits without finding a physician to certify the disability. Of the 75 people arrested in Puerto Rico, 3 are doctors and 1 was a recent retiree from the agency. According to the prosecutors, the doctors were charging patients a fee to falsely diagnose and qualify the patients for disability.
The latest sweep represents an important victory for both law enforcement and taxpayers. Social Security gets all its funding from taxes levied on both workers and employers. When fraud occurs, taxpayers foot the bill.
Most health care fraud cases come to light from whistleblowers. More and more pharmacists, physicians and billing clerks are coming forward to report fraud. If the fraud involves a federally or state funded program such as Social Security or Medicaid, the person reporting the fraud may be entitled to a portion of whatever the government is able to recover. Typical rewards are 20% but in certain cases, whistleblowers can receive up to 30%.
To qualify as a whistleblower, you must have non-public, original source information about a fraud involving a government funded program. To claim your award, the federal False Claims Act requires you to file a complaint under seal in a federal court. While the case is under seal the government is provided the opportunity to investigate.
If you wish to become a whistleblower and have information about health care fraud, give us a call. We represent whistleblowers and help them stop fraud and collect the largest award possible.
Mahany & Ertl – America’s Fraud Lawyers. Offices in Milwaukee, Wisconsin; Detroit, Michigan; Minneapolis, Minnesota; Portland, Maine and San Francisco, California. Services available in many jurisdictions.
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Posted by Brian Mahany, Esq.