The Medicare fraud lawyers at MahanyLaw are investigating a report that Ayman Rifai M.D and Prime Pediatrics are violating Medicaid laws by improperly billing patients. Our investigation is in early stages and no conclusions have been reached.
Medicaid is the insurer of last resort in Georgia. That translates to 894,000 low and middle income children. In fact, Medicaid is the largest insurer of children within the state.
Medicaid is funded with both state and federal tax dollars. Anyone who defrauds Medicaid defrauds every taxpayer in the nation.
Medicare Fraud Allegations about Prime Pediatrics
According to the information we have received, Prime Pediatrics is double billing for some services. In some instances, they are even billing Medicaid when they have already been paid by a patient or private insurance company.
Billing fraud is a common hallmark of Medicaid fraud. Billing fraud comes in many forms and may include:
- double billing,
- billing for services never performed,
- billing for a higher level of service or care that actually received, and
- billing for services that are not medically necessary.
When unnecessary services are offered, patients are put at risk of physical harm.
Medicare fraud can also include illegal kickbacks.
The information that we have about Prime Pediatrics is limited to double billing. In our experience, however, once a clinic or physician decides to defraud Medicaid, it is common to see multiple types of fraud taking place.
Whistleblower Awards for Medicaid Fraud
If Prime Pediatrics is double billing, substantial whistleblower awards may be available. The federal False Claims Act pays awards to people with inside information about fraud involving federally funded healthcare programs. That includes Medicaid, Medicare and Tricare.
To qualify for an award, you must be an original source of the information you are providing. Most of our Medicaid fraud whistleblowers are current or former employees of the wrongdoer. Sometimes, however, we can build a case based on information from a patient.
Claims are filed by filing a sealed (secret) lawsuit in federal court. The Justice Department, assisted by special agents and auditors of Health and Human Services, then gets to investigate. While the case is under investigation, it typically remains sealed by the court. That means no one will likely know who reported the wrongdoing. Generally within a year, the court unseals the case.
Unsealing generally occurs when the government has finished its investigation. At that time, the Justice Department must decide if it wishes to take over prosecution, let the whistleblower’s lawyer prosecute in the name of the government or demonstrate to the court that there is no claim worth pursuing.
If the government takes over prosecution, whistleblower awards are generally between 15% ad 25% of what the government collects. If the whistleblower’s own lawyer prosecutes the case, the award is closer to 30%.
Triple damages and hefty fines can quickly lead to a huge recovery. That means a big whistleblower award.
Georgia Taxpayer Protection False Claims Act
Georgia is one of 29 states with its own False Claims Act. That means Georgia can also pay awards to those with inside information about Medicaid fraud. Percentages and filing requirements are quite similar to the federal act.
How to Claim a False Claims Act Award
If you have information about healthcare fraud involving Prime Pediatrics or any other medical provider, call us. Reporting Medicaid fraud to a toll free hotline does not get you a big cash award. To qualify for an award under the False Claims Act, you need an attorney and need to file a sealed lawsuit. Don’t worry about the expense or hassle of filing a claim, however.
Our whistleblower lawyers take Georgia Medicaid fraud cases on a contingent fee basis. Working with our local counsel, we will investigate, prepare and file your claim. There is no charge for our services unless we collect money on your behalf. In other words, if you don’t get paid, you owe us nothing.
Before closing this post, we wish to remind readers that we are investigating double billing charges at Prime Pediatrics. None of their physicians (Ayman Rifai MD, Susan Hartley MD, Adam Horne MD and Samirah Ashraf MD) have been charged with any wrongdoing. In fact, the Georgia Composite Medical Board reports that all four have clean records and have never been disciplined by the state or successfully sued for malpractice. (Prime Pediatrics is located in Dalton, Georgia.)
For more information, contact attorney Brian Mahany at or by telephone at 414.704.6731 (direct). You can also visit our Medicaid and Medicare Fraud information page. All inquiries protected by the attorney – client privilege and kept confidential.
MahanyLaw – America’s Medicaid Fraud Whistleblower Lawyers
This is an open investigation based on a single whistleblower complaint. We caution readers that until and unless an action is filed and fraud determined, Prime Pediatrics should not be considered to be engaging in Medicare fraud. There no allegations of patient harm or malpractice.