Is Your Health Care Employer Submitting False Documents to Medicaid or Medicare?
Our Attorneys Help Physicians, Nurses, Pharmacists, Sales Reps and other Health Care Professionals Report Fraud and Claim a Cash Reward
Government-funded health care programs like Medicare, Medicaid and TRICARE are in place to provide quality health care services to less-fortunate children, adults, elderly and disabled. Unfortunately, dishonest health care professionals continue schemes to defraud these programs in order to gain a financial profit for themselves.
One way corrupt health care professionals attempt to secure increased Medicaid or Medicare payments is through false documentation. Crooked health care professionals may alter, omit or misrepresent information recorded on medical records, certifications, prescriptions or other documents required to support Medicare or Medicaid payment claims.
Health care professionals may create false documents in order to:
- Increase Medicare or Medicaid payments (recording treatments that never occurred, recording delivery of brand name medications when generics were supplied)
- Cover mistakes (recording that a proper dose of a medication was given when an actual, lesser dose given)
- Appear compliant (filling in inaccurate initials, times or dates to make records appear complete) (having a nurse sign a doctors name on a prescription)
Whether a physician, nurse or staff member is recording entirely false information, is exaggerating or misrepresenting information, or is neglecting to document information altogether, a false document is the ultimate result.
When this document is required to support a claim for payment or approval by Medicare or Medicaid, that claim for payment becomes a false claim – and therefore a violation of the federal False Claims Act (FCA), 31 U.S.C. §§ 3729 – 3733.
Whistleblower provisions of the FCA offer large cash rewards to individuals whose inside knowledge of false documentation leads to successful government recovery. If you feel your health care employer is participating in false documentation, contact Brian Mahany and the MahanyLaw team to learn whether your knowledge makes you eligible for a cash award: or Report Online
Examples of False Documentation in Medicare or Medicaid Claims
Under Federal and State False Claims Acts, hospitals, pharmacies, clinics, physicians, nurses and others who provide health care services for Medicare or Medicaid beneficiaries are prohibited from falsifying documents in order to obtain payment from the government. Conduct that constitutes false documentation resulting in False Claims Act violations includes:
- Recording use of products or services not provided
- Misrepresenting patient or service eligibility for payment
- Exaggerating labor, materials or equipment requirements
- Documenting higher quality pharmaceuticals, supplies or services than actually provided
- Neglecting proper recordkeeping practices, failing to record initials, times, dates or medical details.
- Falsifying document times or dates to fit within eligible Medicaid coverage periods.
- Allowing unlicensed or unauthorized staff to sign prescription forms, certifications or other regulated documents.
- Falsifying patient diagnoses or symptoms on medical records in order to bill government programs for diagnostics, treatments, lab tests, ambulatory transportation, prescription medications or medical devices.
The MahanyLaw team of expert U.S. whistleblower attorney’s is here to help you put a stop to health care fraud. To discuss your false documentation case and learn your options, connect with a member of the MahanyLaw team for a confidential, no-cost consultation: or Report Online
Recent Whistleblower Awards for Tips on Health Care False Documentation
Whistleblower cash awards often range in the hundreds of thousands to millions of dollars for health care professionals who report false documentation in Medicare, Medicaid or TRICARE claims. Here are some examples of recent whistleblower wins announced by the U.S. Department of Justice:
- $1.17 million awarded to Gregory Kuzma from the $5.85 million settlement with Arizona Yavapai Regional Medical Center resolving allegations of misreporting data on employee hours worked on annual cost reports to inflate Medicare payments. – October 4, 2016
- $108,000 awarded to a former practice manager of Maryland Bon Secours Health System from the $400,000 settlement with Bon Secours and Dr. Eugene Chang resolving allegations of billing Medicare for ineligible breast examinations and ultrasounds. – April 18, 2016
- $98 million awarded to Lauren Kieff, a former AstraZenica sales representative, and William St. John LaCorte, a New Orleans physician, from the $784.6 million settlement with Wyeth and Pfizer, Inc. resolving allegations of reporting false prices on drugs, Protonix Oral and Protonix IV to avoid paying Medicaid rebates. – April 27, 2016
- $24 million awarded to Janet Halpin, a former rehabilitation manager of RehabCare Group, and Shawn Fahey, a RehabCare occupational therapist, from the $125 million RehabCare Group and Kindred Healthcare, Inc. settlement resolving allegations they submitted false claims to Medicare for rehabilitation therapy services that it never provided. – January 12, 2016
- $2 million awarded to Meredith Deane, a former sales executive of Maryland’s Dynasplint Systems Inc., from the $10.3 million settlement with Dynasplint Systems and president George Hepburn resolving allegations of improperly billing Medicare for splints provided to skilled nursing facility patients. – December 18, 2015
- $400,000 awarded to Kelly Oxendine from the $2 million settlement with HCA Holdings, Inc. resolving allegations of double billing Medicare for fetal testing. – November 16, 2015
Has your health care employer retaliated against you for reporting concerns of false documentation?
Whistleblower provisions of the FCA protect whistleblowers from employer retaliation.
Whistleblowers who report knowledge of false documentation may sue for damages if their employer fires, threatens, harasses or otherwise discriminates against them in response for reporting fraud, attempting to report fraud, or participating in an investigation around fraudulent conduct.
Our MahanyLaw whistleblower lawyers are willing to take legal action against any health care system involved in illegal conduct, no matter how large. If you have inside information on false documentation and want to claim a cash whistleblower reward, call Brian Mahany and the MahanyLaw whistleblower fraud recovery team for a private, no-fee consultation: or Report Online
How to Report False Documentation and Qualify for Whistleblower Award
If you possess non-public, original information that the federal or state government has been financially harmed by fraudulent conduct, contact our MahanyLaw whistleblower team for an immediate case evaluation.
False Claims Act first-to-file rules allow only the first one to report a case of fraud to collect a whistleblower award, and statutes of limitations apply.
Our experienced attorneys will confidentially review the facts of your case. If you choose to proceed, the MahanyLaw Team will assist you in collecting evidence, filing your claim and maximizing you cash award. Once a verdict or settlement agreement is obtained from a whistleblower action, the whistleblower is awarded between 10% and 30% of the total government recovery. The MahanyLaw team works to prepare your claim for the maximum whistleblower cash award available.
Leading United States whistleblower lawyer Brian Mahany and the MahanyLaw team have decades of experience defending whistleblowers in false claims actions. We work diligently to prepare bulletproof claims that maximize cash awards. Brian Mahany and the MahanyLaw team:
- Won a $170 million whistleblower cash award in the largest whistleblower settlement in history ($16.65 billion)
- Secured a recent $40 million whistleblower cash award
- Helped recover over $10 billion for U.S. taxpayers in 2014 and 2015
- Won numerous client employer retaliation cases
- Focus on protecting client privacy, rights and well-deserved awards
- Maintain high visibility as whistleblower advocates
- Represent whistleblowers in federal and state courts across the U.S.
If you suspect your health care employer of false documentation in Medicaid or Medicare billings, do not hesitate to contact our MahanyLaw whistleblower team for a no-obligation, confidential consultation. Our experienced attorneys will protect your privacy, evaluate your concerns and help you decide how best to proceed: or Report Online