Because Medicare is a national program, damages in Medicare fraud cases are often measured in the hundreds of millions of dollars. Medicaid fraud, which relies on state funds and is a safety net for low income residents, sees a lot of action by the states although the awards paid to whistleblowers are often lower.
More than half the states now have a Medicaid fraud statute that pays whistleblowers awards for information about fraud and corruption. One of those states is Washington, which passed the Washington State Medicaid Fraud False Claims Act in 2012. Patterned after the federal Act, Washington’s law pays whistleblowers up to 30% of whatever the state collects from a wrongdoer. (Up to 25% if the state intervenes and takes over prosecution.)
Earlier this week Washington State Attorney General Bob Ferguson announced a lawsuit against a Vancouver dentist for alleging overbilling Washington’s Medicaid program.
According to the complaint, Liem Do and Phuong-Oanh Thuy Tran, husband and wife dentists, engaged in a complex Medicaid fraud scheme that allegedly netted the couple approximately $1 million. That’s a million dollars snatched from state taxpayers.
Specific allegations in the complaint include billing Medicaid for non covered services, wrongfully coding procedures to obtain additional Medicaid monies (“upcoding”) and billing for procedures where there is no evidence that the procedure was performed (false billing).
The complaint claims the billing clerks in the four offices operated by the dentists were not adequately trained. That doesn’t account for the billing errors or problems, however. The state claims that at the end of the day Dr. Do would review the ledgers and often upcode specific bills even though there was no documentation to suggest extra services had been performed.
Because Washington’s Medicaid fraud law is patterned after the federal False Claims Act, the state is entitled to triple damages and up to $11,000 per false Medicaid bill submitted. It’s easy to see that even small cases, damages can quickly become worth millions.
To become a whistleblower and earn an award, one needs original source information about fraud involving the state funded Medicaid program. If you think you know of fraud and are wondering if you are eligible to receive a whistleblower award, give us a call. (We helped our clients receive over $100 million in award payments last year.)
Don’t Rely on Medicaid Fraud Tip Lines if You Want a Reward
Calling a hotline or filling out an online form does not get you an award, however. Washington’s Medicaid Fraud Control Unit has an online form but instructions for the firm make it clear that you won’t be notified of the results. The only way to qualify for an award in most states and on the national level is to file a claim under the state’s False Claims Act or similar procedure. In most states that means filing a sealed lawsuit in court.
MahanyLaw – America’s Medicare and Medicaid Fraud Lawyers