Are you a health care professional who’s being investigated for submitting a false claim? Our team of false claims act attorneys has a proven track record at defending clients against false claims. We have extensive experience and can help.
The Federal False Claims Act
The false claims act is a federal law that applies to any business or individual that has a contract with and is paid for services by the government. The false claims act covers schemes such as Medicare and Medicaid.
Physicians, health care organizations, and clinics will be held liable if they knowingly submit a false claim. Under this law, an individual or organization will only be held responsible if the false or fraudulent claim was filed with the intent of defrauding the government. If the health care professional has submitted a fraudulent medicare claim to gain profit, this would be considered a false claim.
If the physician or business fails to act with due diligence, they may also be charged with a false claim. For example, if a billing code has been changed and the practice should have known this, but unconsciously submitted an invalid code.
Fraudulent Claims Act Penalties
If your business is under investigation for making a false claim, then this is likely to be a very stressful and invasive time. We understand that your business will face many challenges during the investigation.
The False claims act contains penalties that are civil as well as more serious and criminal, depending on the severity of the case. Each case is unique, and our false claims attorney will help prepare your case and defend against any allegations made about you and your business. It’s often not apparent at the start of an investigation whether the government believes the case to be a civil matter or intends to press criminal liabilities. Usually, it will seem like the government entities are investigating a civil lawsuit. They could then uncover more severe problems, and the business owner will be charged with criminal activity.
If you’ve been charged with civil liability, this may result in fines of up to three times the cost of damages. You’ll also receive a fine of around $ 11,000 for each false or invalid claim which has been knowingly submitted.
In more severe cases, Health care providers will receive criminal liability. The penalties for those who knowingly submit fraudulent or fictitious are critical and will have life-changing effects. If you or your business is found to be making fraudulent claims, this could result in five-year incarceration in federal prison. You may also receive fines of $ 250,000 for an individual or $ 500,000 if your company is found to be guilty of a federal felony. If you receive a misdemeanor conviction, you’re likely to be charged between $ 100,000 and $ 200,000 for each claim.
If you are facing false claim charges, it’s important to get legal representation as soon as possible. Our false claims attorney can help limit the damage to your business and reputation.
Qui Tam Lawsuit and defense
In many cases, a false claims investigation has been initiated by a whistleblower rather than the government. A whistleblower is usually someone who has an interest in the business and is knowledgeable about their activities. For example, an employee or former employee, a patient, or a competitor. The government offers a financial incentive to anyone who can report original information which they can use to hold a company or individual liable.
Cases that involve a whistleblower, known as the ‘relator,’ are called qui tam lawsuits. This is a Latin expression, which means “he who sues for the king and for himself.” In a Qui Tam lawsuit, the relator can recover money which has been fraudulently taken from the United States government. This is achieved by the relator, providing information which will prove that the federal government has been defrauded.
How does a Qui Tam Lawsuit work?
The Qui Tam Lawsuit starts with a Complaint. In most cases, the relator will file a complaint with a federal court. They will work with a lawyer to create a claim against the defendants; the health care professional, organization, or both.
The relator’s identity is kept anonymous to protect them from any adverse effects of the investigation. Qui tam lawsuits are filed under seal, and a copy is only given to a limited number of people. The court’s clerk will divulge the complaint to an assigned judge as well as government officials that are involved with the case.
The case may be kept sealed for six months, and extensions are often granted until government entities have investigated the complaint.
After a complaint has been filed, government officials will look at it and see where the allegations are genuine and whether there is enough evidence. If the claim seems unsupported, they will reject the complaint, and no further action will be taken.
However, If the complaint looks promising, further investigations will need to be made. Federal law enforcement agencies will be called in to investigate. Organizations such as the FBI, the DEA, or the U.S. Attorney’s Office can all help with the investigation stage.
A factual investigation will usually be carried out through OIG subpoenas. The business or individual who is being investigated will be required to produce evidence such as corporate, financial, and nosiness records. They will also be asked for a record of the bills they have submitted to the government health care benefit programs.
The government will then carefully review each of the records they have collected. Government agencies will negotiation with a health care defense lawyer and decide whether they will support the realtor or not. If they decide that the realtor and the investigations have provided enough information, they will then intervene in the case. Otherwise, the government will drop out of the case, and the realtor can decide whether to continue alone.
In cases where the government decides to Intervene, they will have to go through an approval process that involves the Department of Justice (DOJ). During the intervention, the Department of Justice will usually add to the initial complaint. They will include additional causes of actions; these may consist of the Anti-Kickback Act and the Truth in Negotiation Act.
While the government is serving subpoenas and carrying out an investigation into the defendant’s actions, negotiations will also be taking place between lawyers hired by the government and the defendant. The whole process could take several months, depending on the severity of the case and how difficult it is to analyze. The government will them evaluate a qui tam, and finally, the case will go to court before it is fully resolved.
If the accused has been found liable, the health care professional or business entity who was accused of fraud will be prosecuted. They are likely to be fined and may also be required to pay three times the government’s losses. This money will cover legal fees and other expenses. They will also be fined up to $ 11,000 for each fraudulent claim that was submitted. This will have a negative effect on the business, organization, or individual and may even cause bankruptcy as fines can amass to thousands, if not millions of dollars.
The government provides incentives for qui tam relators by offering them up to 25 percent of the total monetary value of the fines collected. The incentivized amount could rise to 30 percent if the government hasn’t intervened in the case.
Types of Qui Tam Lawsuits
There are several different types of Qui tam lawsuits that use other laws and statues to hold companies and health care professionals liable. In recent times there has been an ever-increasing amount of Qui Tam lawsuits. Many of these are dealt with under the false claims act.
Qui tam lawsuits often target those who have been involved in providing unlawful kickbacks such as money or services paid with the intent to provoke Government business. An example of a qui tam lawsuit involving kickback was a $116 million settlement, which was not intervened by the government. The complaint was initially reported by a former employee of a pharmacy who knew that unlawful kickbacks had been paid to several nursing homes in the area to encourage purchases of medications.
Qui tam cases are often filed due to medical providers, including doctors’ surgeries and hospitals, carrying out billing fraud. In these cases, the organization will bill medicare or Medicaid for false treatments or for treatments that are, in some way, fraudulent. A medicare claim is forged if it has been double-billed, or upcoded. This is where providers bill for a more expensive treatment then the patient has received. We have seen cases recently where doctors’ signatures have been forged, and patient records falsified.
Relators can file a qui tam lawsuit if they suspect a doctor, hospital, or pharmacist unlawful marketing of medication. Off labeling is when a doctor prescribes a drug for a purpose other than for what it has been intended for.
Our False Claims Act Attorneys Can Help You
Is your practice or organization being investigated?
Are you are a physician or other health care professional who is being investigated under the false claims act? Perhaps you have had a Qui Tam lawsuit filed against you. If so, you need to ensure you invest your time and money into achieving fantastic legal representation. Our team of experienced health care fraud attorneys can prepare a case that will help defend against your business. In some cases, we can even get your case dismissed altogether. We are a hard-working team of lawyers who utilize our combined skills and have earned an impeccable reputation.
Our clients place their trust in us daily, as we have experience of working with many laws. These include the false claims act, stark law, and Qui Tam lawsuits. We have decades of experience and can put forward compelling arguments that will help fight against any allegations that have been made against your business. If you’re a physician who wants to minimize your risk of being investigated in the future, contact us for advice and support. The number of health care businesses under investigation is rising all the time, and government entities are employed to make standard checks. Many lawsuits are filed against doctors for innocent mistakes. Make sure that you are aware of the risks and know what to do if you are unexpectedly being investigated.
We aim to help clients minimize the chance of being found guilty and work hard to eliminate penalties such as fines and prison sentences. Our main aim is to serve you; many of our clients can leave the court with no civil or criminal liabilities. Our team works in an efficient manner, which is both time and cost-effective. We are familiar with medical terminology and medical law.
Have you witnessed any health care fraud?
If you believe you are a witness to any form of fraud in your workplace, contact us today, and we can advise you on how to move forward. We have an experienced team of qui tam lawsuit lawyers who can provide you with ongoing advice about regulatory compliance issues. We can also intervene if an investigation has already been made.
Our Qui Tam defense team will strive to protect you against the federal government, America’s most prosperous organization, as well as the country’s largest employer. The government has vast resources of money and employees, which will be used against you.
By the time you realize you’re being investigated, the government will already have a team of investigators, prosecutors, and federal agents working on your case. If you choose to employ our health care fraud lawyers, we will work as a team to handle your situation. We work in an effective manner that combines the efforts of each attorney on our team. We treat each case confidentiality and with the urgency it deserves.
Our Defense Strategies
We combine our fantastic negotiation skills with attention to detail and knowledge of government and medical policies. Our false claims act attorneys have worked on hundreds of similar cases before throughout America. We use proven defense strategies to maximize our chances of limiting or dismissing civil and criminal charges.
Our years of experience allow us to determine the nature of the case quickly and decide whether it is likely to be civil or criminal. We’ll find out what the government’s goals are and will work towards finding a resolution.
If you’ve been accused of fraud, we will confront the whistleblower and make a convincing case that will destroy their credibility. By doing this, we will aim to convince the government that the case doesn’t need their intervention or support.
Call Our False Claims Attorney Today
If you are a health care professional who is facing government program fraud, don’t hesitate to call us today. We offer advice and defense against all False Claims Act matter and qui tam lawsuits, whether they are civil or criminal. Our false claims act attorney can represent you in internal investigations, implement compliance programs, and trial services. If you would like to discuss your situation with us, contact us today by phone at 888-402-4054.