Qui Tam, Whistleblower & False Claims Act Blog

IRS Tax Fraud Confidential Whistleblower Reward Information by IRS Tax Fraud Illegal Offshore Account Whistleblower Lawyer Jason S. Coomer

2012-01-27T19:24:00.000-08:00

IRS Illegal Offshore Account Tax Fraud Whistleblower Lawsuit, Corporate Tax Fraud Whistleblower Reward Lawsuit, IRS Illegal Offshore Account Tax Fraud Whistleblower Reward Lawsuit, Transfer Price Scheme Tax Fraud Whistleblower Lawsuit, & other IRS Whistleblower Reward Lawsuit Information by IRS Illegal Offshore Account Tax Fraud Lawyer and Transfer Payment Tax Fraud Whistleblower Reward Lawyer Jason S. Coomer

Illegal Offshore Account Tax Fraud and Transfer Payment Tax Fraud are two forms of corporate tax fraud that are committed by large multinational corporations. The IRS is offering rewards and protections for IRS whistleblowers and IRS informants that work through Illegal Offshore Account Tax Fraud Whistleblower Lawyers, Multinational Corporate Tax Fraud Whistleblower Lawyers, and Transfer Payment Tax Fraud Whistleblower Lawyers to identify tax fraud schemes that cost the United States Billions of dollars.

IRS Illegal Offshore Account Tax Fraud Lawyer, Corporate Tax Fraud Whistleblower Reward Lawyer, IRS Illegal Offshore Account Tax Fraud Whistleblower Reward Lawyer, IRS Transfer Price Scheme Tax Fraud Lawyer, and IRS Whistleblower Reward Lawyer

Transfer pricing schemes involve the overpricing of imports and/or the underpricing of exports between related companies in different countries for the purpose of transferring profits or revenue out of the United States in order to evade taxes. The profits and revenue end up in a country that has a lower corporate tax rate than the US. These fraudulent pricing schemes can be used both for stock manipulation and corporate tax fraud. For more information on Corporate Tax Fraud Whistleblower Actions, please go to the following: Tax Fraud Whistleblower Reward Lawsuit, IRS Tax Fraud Whistleblower Award Lawsuit, and Corporate Tax Fraud Lawsuit Information web page.

Illegal Offshore Account Tax Fraud Lawsuit, Corporate Tax Fraud Whistleblower Reward Lawsuit, IRS Illegal Offshore Account Tax Fraud Whistleblower Reward Lawsuit, Transfer Price Scheme Tax Fraud Lawsuit, IRS Whistleblower Reward Lawsuit, & IRS Whistleblower Payment for Detection of Fraud Lawsuit Information

In 2006, the Tax Relief and Health Care Act that was signed into law included a whistleblower reward amendment that created mandatory reward language to the IRS to create a mandatory economic incentive to encourage tax fraud whistleblowers to step forward to help the government detect large scale fraudulent schemes. By offering large potential rewards for reporting multimillion tax fraud schemes, the IRS has received hundreds of tax fraud tips from tax fraud informants regarding taxpayer fraud and massive violations of the tax code costing taxpayers Billions of dollars. Many of the tips already received include fraud schemes of hundreds of millions and tens of millions of dollars. It is estimated that this programs will result in hundreds of billions of dollars or even Trillions of dollars in tax fraud being detected.

The economic incentives in the Tax Whistleblower Reward Programs are designed to encourage insider tax fraud informants and tax fraud whistleblowers with knowledge and evidence of large tax violations and tax fraud schemes to step forward and report the massive tax fraud. The IRS is hoping that there will be several tax fraud whistleblowers and tax fraud informants that will help them detect and collect on an estimated $3 Trillion in illegal offshore accounts as well as several other tax-avoidance schemes that have been perpetrated by billionaires and millionaires as well as large corporations.

Stock Manipulation Scheme Lawsuit, Corporate Accounting Fraud Lawsuit, Fraudulent Accounting Lawsuit, False Accounting Statement Lawsuit, SEC Whistleblower Incentive Program Lawsuit, & SEC Bounty Action Lawsuit Information by Texas Corporate Accounting Fraud Lawyer, Stock Manipulation Lawyer, & False Accounting Statement Lawyer Jason Coomer

Stock manipulations schemes, false accounting statements, and other types of corporate accounting fraud cost pension funds and investors hundreds of Billions of dollars. These fraudulent business practices are the target of new SEC Bounty Action laws and rules that encourage whistleblowers to anonymously step up and blow the whistle through a Bounty Action Lawyer on illegal stock manipulation schemes, false accounting, accounting fraud, Ponzi schemes, and other SEC violations. By working with a stock manipulation bounty action lawyer to expose stock manipulation schemes, false misleading information on a company's financial statements, false information on Securities and Exchange Commission (SEC) filings, insider trading; embezzlement by stockbrokers; and other securities fraud, a SEC whistleblower can receive a large financial reward.

Illegal Offshore Account Tax Fraud Lawsuit, Corporate Tax Fraud Whistleblower Reward Lawsuit, IRS Illegal Offshore Account Tax Fraud Whistleblower Reward Lawsuit, Transfer Price Scheme Tax Fraud Lawsuit, & IRS Whistleblower Reward Lawsuit Information by Illegal Offshore Account Tax Fraud Lawyer and Transfer Payment Tax Fraud Whistleblower Reward Lawyer Jason S. Coomer

The Federal Government including the SEC and IRS have recently amended and strengthened whistleblower reward laws to encourage accountant whistleblowers, financial analyst whistleblowers, and other high end professional whistleblowers with evidence of Accounting Fraud, Tax Fraud, Stock Manipulation Fraud, and other Investment Fraud to step up and blow the whistle on these fraud schemes. By working through a Accounting Fraud Whistleblower Lawyer, Tax Fraud Whistleblower Lawyer, Stock Manipulation Fraud Whistleblower Lawyer, or other SEC Investment Fraud Whistleblower Lawyer, these whistleblowers can protect their identity and obtain large economic rewards.

For more information on these Whistleblower Reward, Bounty Action, and Protection Laws, feel free to go to the following web pages: Corporate Tax Fraud Lawsuits & Tax Fraud Whistleblower Lawsuit Information, Employee Whistleblower Award & Recovery Lawsuit Information, Corporate Illegal Kickback & Contract Bribe Whistelblower Award Lawsuit Information, Foreign Corrupt Practices Act Lawyer and SEC Bounty Action Lawsuit Information, Confidential Financial Analyst Whistleblower Reward Lawsuit Information, Stock Manipulation Scheme & Corporate Accounting Fraud Lawsuit Information, and Multinational Corporation Tax Fraud Web Page Illegal Offshore Account Whistleblower and Multinational Corporation Fraudulent Transfer Payment Bounty Lawsuit Information

Fueled by Economic Incentives Many States Are Enacting Strong Medicaid Fraud Whistleblower Reward Laws That Provide Rewards and Protection to Whistleblowers by Medicaid Fraud Whistleblower Lawyer Jason S. Coomer

2012-01-23T08:41:00.000-08:00

New State Medicaid Whistleblower Reward Laws Allow Medicaid Fraud Whistleblower Lawyers, Medicaid Hospital Employee Whistleblower Reward Lawyers, Hospital Whistleblower Lawyers, and Hospital Medicaid Fraud Whistleblower Lawyers to Protect Hospital Employee Whistleblowers From Retaliation

New state whistleblower reward laws are expanding the ability of Medicaid fraud whistleblowers to collect large economic rewards to encourage health care providers to blow the whistle on health care fraud including illegal Medicaid retention of overpayments, Medicaid illegal kickback schemes, Medicaid upcoding practices, Medicaid double billing practices, Medicaid false coding practices, Medicaid unbundling, and other fraudulent Medicaid billing practices.

The 2009 Fraud Enforcement and Recovery Act (FERA) and many new state Medicaid fraud whistleblower laws are expanding Medicaid fraud whistleblower recovery laws and other Bounty Reward Actions to increase potential rewards for relators, expand potential liability for Medicaid fraud criminals and violators, and to increase protections to Medicaid fraud whistleblowers. These new laws are designed to help the Federal government and state governments identify, recoup, and crack down on Medicaid fraud, Medicare fraud, and other forms of health care fraud which is estimated to be over $100 Billion per year.

With Medicare and Medicaid costs continuing to grow and many government budgets being tight, it is essential that health care providers with knowledge of Medicaid fraud, Medicare fraud, or other health care fraud to step up and expose the health care fraud and systematic Medicaid fraud that is the fasting growing and most lucrative crimes in the United States.

In developing and strengthening Medicaid fraud whistleblower laws, governments are setting up increased whistleblower protections and economic incentives to encourage health care providers to blow the whistle on traditional qui tam health care fraud causes of action and are expanding the causes of action to include rewards to whistleblowers that expose retention of Medicaid overpayments. Many of these False Claims Act statutes and Medicaid Fraud statutes have also been expanded to include government contractor false claims, government grantee false claims, and other recipients of government money that submit false claims to obtain this money.

For more information on potential Medicaid fraud whistleblower recoveries and Medicaid fraud whistleblower protections, please feel free to go to the following web pages: Medicaid Fraud Whistleblower Lawsuit and Medicaid Fraud Whistleblower Reward Lawsuit Information and Medicaid Fraud Whistleblower Lawyer and Medicaid Whistleblower Reward Lawyer.

If your health care company has people that are committing Medicaid fraud, it is important to contact a Medicaid fraud whistleblower reward lawyer, Medicaid illegal kickback whistleblower reward lawyer, Medicaid upcoding whistleblower reward lawyer, Medicaid protected whistleblower double billing lawyer, Medicaid false coding whistleblower reward lawyer, Medicaid unbundling fraud whistleblower lawyer, or other health care fraud whistleblower lawyer to maximize your ability to obtain a substantial whistleblower recovery, understand whistleblower protections from potential retaliation, and protect yourself from potential liability.

Off Label Drug Marketing Fraud Lawsuit and Drug Formulary Fraud Lawsut Information

2011-02-27T13:52:00.000-08:00

Drug Formulary Fraud Whistleblower Lawsuit Information, Drug Company Off Label Marketing Fraud Whistleblower Lawsuit Information, Hospital Formulary Drug Fraud Whistleblower Lawsuit Information, Drug Kickback Lasuit Information, and Drug Fraud Marketing Whistleblower Lawsuit Information (Off Label Marketing Fraud, Hospital Formulary Fraud, & Drug Kickback Whistleblower Lawyer)

Many health care professions have become aware of the strong influence that drug companies now have in determining community standards of care for medication use in patients. These drug companies push drug samples into many hospitals and often use powerful forms of manipulation including biased research, influencing key medical doctors, and kickbacks to get their drugs placed on hospital formularies.

Because of the immense power and influence of drug companies, it is becoming common to have drug marketing executives and representative to be able to influence what drugs whole communities. In many situations the drug companies are more powerful than individual doctors that are forced to follow hospital formularies. This drug company manipulation of the medical community can be extremely dangerous because it takes important medical decisions out of the hands of individual medical doctors and allows the drug companies to push potentially dangerous drugs for off-label drug uses and in inappropriate situations.

The drug industry's main goal is to make a profit. Each drug company is trying to sell as much of their drug as they can regardless of the potential danger to patients or if there are cheaper more effective alternatives available. If the marketing executives and drug representatives can get their drug placed on a hospital formulary or make it the standard of care in a community, they are able to make lots of money. Once this is accomplished there are economic incentives to keep expanding the use of the drug to keep expanding off-label uses.

Recently several large drug companies have been caught fraudulently marketing drugs for off-label purposes. These drug companies have had to pay Billions of dollars for Medicare Marketing Fraud Off-Label Lawsuits, Medicaid Marketing Fraud Off-Label Lawsuits, and other health care fraud lawsuits. Despite these large fines, Drug Companies have continued this practice because they are making profits of Hundreds of Billions of Dollars.

"WASHINGTON (AP) -- Federal prosecutors hit Pfizer Inc. with a record-breaking $2.3 billion in fines Wednesday and called the world's largest drug maker a repeating corporate cheat for illegal drug promotions that plied doctors with free golf, massages, and resort junkets." Pfizer to pay record $2.3B penalty over promotions Repeat offender Pfizer paying record $2.3B settlement for illegal drug promotions By Devlin Barrett, Associated Press Writer On Wednesday September 2, 2009, 3:47 pm EDT

The Department of Justice has announced that this penalty is a warning to all drug manufacturers that criminal and civil prosecution of fraudulent drug marketing, fraudulent off label marketing, illegal kickbacks, and other fraud schemes. They have also announced that there are several new Medicare Fraud and Medicaid Fraud Law Enforcement Teams that are cracking down on Medicare Fraud and Medicaid Fraud Schemes. These teams will be investigating and prosecuting people that have profited from these scheme and people that knew about the fraudulent scheme, but failed to report them.

Medical doctor whistleblowers, physician whistleblowers, neurologist whistleblowers, health care administrator whistleblowers, pharmacist whistleblowers, nurse whistleblowers, or other medical professional whistleblowers are needed to blow the whistle on Billions of dollars in Off Label Drug Fraud. and Hospital Formulary Drug Fraud. If you are aware of hospital formulary drug fraud, fraudulent off label marketing practices, or illegal drug kickbacks, it is extremely important that you step forward and blow the whistleblower on the fraud. It not only helps prevent the billions of dollars that are stolen each year from Medicare, Medicaid, and taxpayers, but can lead to a large whistleblower reward for properly reporting the fraud and can help prevent potential criminal liability for failing to report drug marketing fraud.

For more information on a Drug Formulary Fraud Whistleblower Lawsuit or Drug Company Off Label Marketing Fraud Whistleblower Lawsuit, please go to the following webpage on Hospital Formulary Drug Fraud Whistleblower Lawsuit Information, Drug Kickback Lawsuit Information, and Drug Fraud Marketing Whistleblower Lawsuit Information.

Securties Fraud Whistleblower Lawsuit Information and Investment Fraud Whistleblower Bounty Actions

2011-01-23T09:38:00.000-08:00

Financial Fraud Whistleblower Lawsuits, Securities Fraud Whistleblower Bounty Actions, SEC Whistleblower Incentive Program Claims, Securties Fraud Whistleblower Lawsuit Information, & Dodd-Frank Act Financial Fraud Whistleblower Bounty Actions Provide Economic Incentives for Wall Street Fraud and Financial Fraud Whistleblowers by Texas Securities, Commodity, and Financial Fraud Whistleblower Lawyer Jason Coomer

In the aftermath of unregulated investments that brought the US economy to the brink of collapse and cost investors Trillions of dollars, the federal government is offering financial incentives to securities fraud whistleblowers, commodity fraud whistleblowers, stimulus fraud whistleblowers, and other financial fraud whistleblowers to step up and blow the whistle on investment fraud, Securities and Exchange Commission SEC violations, Commodity Future Trading Commission CFTC violations, derivative fraud, securities fraud and other forms of financial fraud. Recent legislation not only strengthens existing qui tam and whistleblower protection laws, but also creates new whistleblower bounties that can be collected by whistleblowers that properly report SEC violations, financial fraud, securities fraud, commodities fraud, and stimulus fraud.

These new whistleblower bounty actions are expected to encourage Wall Street whistleblowers and other investment fraud whistleblowers to come forward and blow the whistle on large scale investment fraud. By encouraging investment fraud whistleblowers to expose investment fraud scams and SEC violations committed by the financial industry, Congress is hoping to rebuild confidence in Wall Street and the Financial Sector for investors.

Dodd-Frank Wall Street Reform and Consumer Protection Act Created the SEC Incentive Program Allowing New Whistleblower Bounty Provisions that allows Qualified Financial Fraud Whistleblowers, Securities Fraud Whistleblowers, and SEC Violation Whistleblowers to Collect Rewards for SEC Bounty Claims

In July 2010, the Dodd-Frank Wall Street Reform and Consumer Protection Act was signed into law which includes significant new financial fraud bounty whistleblower provisions. These provisions create economic incentives for SEC violation whistleblowers and other financial fraud whistleblowers with "original information" of SEC violations and financial fraud to blow the on large scale financial fraud and SEC violations.

These SEC bounty claims must be brought voluntarily under the SEC Bounty Programs by one or more individuals. The whistleblower or whistleblowers must be a natural person or natural persons, companies or other entity is not eligible to be financial fraud bounty whistleblowers. Successful SEC violation bounty whistleblowers and financial fraud whistleblowers can collect financial rewards for whistleblower bounty actions that result in the imposition of monetary sanctions of greater than $1 million dollars. This new financial fraud SEC bounty program is called the "Securities Whistleblower Incentives and Protection".

Through SEC Whistleblower Bounty Actions the SEC will award between ten percent and thirty percent of the money collected to a qualified whistleblower who voluntarily provides the SEC with original information about a violation of the securities laws that leads to a successful enforcement of an action brought by the SEC that results in monetary sanctions exceeding $1,000,000.00.

So long as the financial fraud whistleblower or financial fraud whistleblowers base their claims on "original information", any person (not just an employee or insider) may file a SEC financial fraud bounty claim. Further, if the financial fraud whistleblower is represented by an attorney, the whistleblower may file the financial fraud bounty claim anonymously. However, before the financial fraud bounty award is paid, the whistleblower's identity shall be revealed to the SEC and SEC shall be provided information about the whistleblower that it requests.

Securities Fraud Whistleblower Lawsuit Information, SEC Whistleblower Incentive Program Lawsuit Information, Financial Fraud Derivatives Lawsuit Information, Financial Fraud Whistleblower Lawsuit Information, & Financial Fraud Bounty Lawsuit Information

Securities fraud, also known as stock fraud and investment fraud, is the unlawful practice of inducing investors to make investment decisions on the basis of false information, frequently resulting in losses, in violation of the securities laws. Securities fraud whistleblower lawsuits include deceptive practices in the stock and commodity markets, and occur when investors are enticed to part with their money based on fraudulent misrepresentations.

Securities fraud whistleblower lawsuits include outright theft from investors and misstatements on a public company's financial reports as well as a wide range of other actions, including insider trading, front running and other illegal acts on the trading floor of a stock or commodity exchange. Evidence for a securities fraud whistleblower lawsuit may include:

False or misleading information on a company's financial statement;
False or misleading information on Securities and Exchange Commission (SEC) filings;
Lying to corporate auditors;
Insider trading;
Stock manipulation schemes;
Embezzlement by stockbrokers;
Manipulation of a security’s price or volume;
Fraudulent or unregistered offer or sale of securities, including Ponzi schemes, high yield investment programs or other investment programs;
Brokerage Account and Retirement Account Fraud;
False or misleading statements about a company;
Failure to file required reports with the SEC;
Abusive naked short selling;
Theft or misappropriation of funds or securities;
Fraudulent conduct or other problems associated with municipal securities transactions or public pension plans; and
Bribery of foreign officials

Through new legislation the federal government is offering financial incentives to securities fraud whistleblowers and other financial fraud whistleblowers to step up and blow the whistle on properly reporting financial fraud including the above listed forms of securities fraud that lead to SEC violations and fines. These new whistleblower bounties can be collected by whistleblowers that properly report SEC violations, financial fraud, securities fraud, commodities fraud, and stimulus fraud.

Other forms of SEC Violations including reporting problems with a brokerage or advisory account; fraudulently preventing access to funds or securities; fraudulent order handling, trade execution, or confirmations; fraudulent fees, mark-ups or commissions; and inaccurate or misleading disclosures by financial professionals, may also lead to potential SEC bounties, if the fraudulent acts result in fines of over $1 million and are properly reported.

Securities Fraud Whistleblower Lawsuit Information, SEC Violation Whistleblower Bounty Lawsuit Information, Dodd-Frank Act Financial Fraud Whistleblower Bounty Lawsuit Information, SEC Whistleblower Incentive Program Lawsuit Information, Investment Fraud Whistleblower Lawsuit Information, Securities Fraud Action Information, Commodity Fraud Action Information, and SEC Fraud Whistleblower Lawsuit Information

Financial Fraud Whistleblower Lawsuits, Securities Fraud Whistleblower Lawsuits, Commodity Fraud Whistleblower Lawsuits, Stimulus Fraud Whistleblower Lawsuits, and SEC Violation Whistleblower Lawsuits will become more common with the enactment of laws like the Dodd-Frank Wall Street Reform and Consumer Protection Act that create bounties that can be collected by whistleblowers that properly report SEC violations, financial fraud, securities fraud, commodities fraud, and stimulus fraud that result in monetary sanctions over one million dollars ($1,000,000.00). The SEC can award the whistleblower up to 30% of the money collected.

By creating whistleblower bounties for investors and people with specific information of financial fraud, it is expected that hard to detect financial fraud including derivative market fraud and investment fraud will be exposed to help regulate the financial market and prevent large investment corporations, banks, hedge funds, and other large corporations from committing financial fraud of billions of dollars.

TARP Fraud Whistleblower Lawsuits, Bail Out Fraud Whistleblower Lawsuits, Financial Fraud Federal False Claims Act Lawsuits, and Stimulus Fraud Qui Tam Whistleblower Lawsuits

Many financial fraud whistleblower lawsuits may include also include elements of stimulus fraud whistleblower qui tam lawsuits or other Federal False Claims Act Lawsuits. These potential Financial Fraud Actions under the Federal False Claims Act may allow a stimulus fraud whistleblower or other financial fraud whistleblower to potentially collect a large recovery for blowing the whistle on financial fraud. The Troubled Asset Relief Program (TARP) is a $700 Billion Bail Out of the troubled United States Banking and Credit System. It was designed to unfreeze the credit market and enable the government to purchase residential and commercial mortgage assets, including whole loans and securities. Unfortunately, after it was announced numerous Corporate interests began scheming on how to get as much of the Bail Out money as possible and use the money not for its intended purpose, but to enrich the corporations, shareholders, and CEOs that were able to get a portion of the money.

When a government imposes a penalty, for the doing or not doing an act, and gives that penalty in part to whistleblowers that will sue for the same, and the other part of the recovery goes to the government, and makes it recoverable by action, such actions are called "qui tam actions", the plaintiff is suing on their own behalf as well for the government and taxpayers. Qui tam provisions of the False Claims Act are based on the theory that one of the least expensive and most effective means of preventing frauds on taxpayers and the government is to make the perpetrators of government fraud liable to actions by private persons acting under the strong stimulus of personal ill will or the hope of gain.

The strong public policy behind creating an economic gain for whistleblowers is that the government would be significantly less likely to learn of the allegations of fraud, but for persons in certain positions with specialized knowledge of fraud that has been committed. Congress has made it clear that creating this economic incentive is beneficial not only for the government, taxpayers, and the realtor, but is an efficient method of regulating government to prevent fraud and fraudulent schemes.

The central purpose of the qui tam provisions of the False Claims Act is to set up incentives to supplement government regulation and enforcement by encouraging whistleblowers with specialized knowledge of fraud going on in the government to blow the whistle on the crime.

The whistleblower's share of recovery is a maximum of 30 percent and the government's prior knowledge of fraud now does not necessarily bar a whistleblower from collecting lost revenue. If the government takes over the lawsuit, the relator can "continue as a party to the action." The defendant is also required to pay for the relator's attorney fees. The whistleblower is also protected from retaliatory actions by his or her employer. As a result a 1986 amendment to the False Claims Act, qui tam lawsuits have increased dramatically. Though the amendment was first made for corrupt defense contractors, the amendment has uncovered billions of dollars in health care fraud and will probably apply to fraudulently obtained TARP and Bail Out Funds.

Through Federal False Claims Act Whistleblower Lawsuits, Qui Tam Lawsuits, and other Government Fraud Lawsuits, billions of dollars have been recovered from fraudulent government contractors and corporations that have committed fraud and stolen large amounts of money from the government and taxpayers. By seeking the knowledge of sophisticated investors, the SEC is seeking to use their specialized knowledge of securities and investments to expose complicated securities fraud and investment fraud that threaten the public confidence in Wall Street, the financial industry, and investing.

For more information on Investment Fraud Whistleblower Lawsuits including Securities Fraud, Derivatives Fraud, Investment Fraud, and Commodity Fraud follow the following link: Securities Fraud Whistleblower Bounty Actions and Financial Fraud Whistleblower Lawsuits.

Drug Calibration Fraud Whistleblower Lawsuit Information and Drug Safety Fraud Whistleblower Lawsuit Information

2011-01-23T09:10:00.000-08:00

Drug Calibration Fraud Whistleblower Lawsuit Information, Drug Safety Fraud Whistleblower Lawsuit Information, Adulterated Drug Whistleblower Lawsuit Information, Contaminated Drug Whistleblower Lawsuit Information, and Drug Quality Assurance Whistleblower Lawsuit Information by Drug Safety Fraud Whistleblower, Contaminated Drug Whistleblower, Adulterated Drug Whistleblower, Drug Calibration Fraud Whistleblower, and Pharmaceutical Quality Assurance Whistleblower Lawyer Jason S. Coomer

It is extremely important that pharmaceutical whistleblowers including Drug Quality Fraud Assurance Whistleblowers, Drug Calibration Fraud Whistleblowers, and other Drug Safety Whistleblowers continue to step forward to blow the whistle on adulterated drugs that threaten the health and safety of the people taking medications. Because of the serious potential danger to the public that can be caused by giving contaminated drugs or improperly calibrated drugs, it is vitally important that whistleblowers help make sure that drugs are properly calibrated and not contaminated. Further, it is clear that the government will not tolerate any lapses in safety standards from pharmaceutical manufacturers.

Public policy dictates that whistleblowers and the government work together through large economic incentives and law enforcement to regulate the $800 Billion a year Pharmaceutical Industry to make sure that drug calibration fraud and drug safety fraud are not occurring. By encouraging pharmaceutical quality assurance, calibration, and safety professionals to step forward and expose fraudulent practices that create adulterated drugs, large awards through the False Claims Act protect the health and lives of children, men, and women. These awards encourage insiders with special knowledge of drug calibration fraud and drug safety fraud to come forward and blow the whistle on large companies that value profits over drug safety.

There are several keys to a successful False Claims Act Qui Tam Whistleblower action including 1) obtaining original and specialized information of the fraud, 2) being the first to file regarding the specific fraud, and 3) protecting the whistleblower for retaliation. Pharmaceutical whistleblowers including Drug Quality Assurance Whistleblowers, Drug Calibration Whistleblowers, and other Drug Safety Whistleblowers that timely and properly blow the whistle on defective and dangerous drugs, may receive a large amount of money for being the first to properly report fraudulent disregard for safety standards and pharmaceutical policies that hide adulterated drugs.

Pharmaceutical Quality Assurance Whistleblower Lawsuit Information, Drug Safety Whistleblower Lawsuit Information, Adulterated Drug Whistleblower Lawsuit Information, Contaminated Drug Whistleblower Lawsuit Information, and Pharmaceutical Drug Calibration Whistleblower Qui Tam Lawsuit Information by Drug Quality Whistleblower, Contaminated Drug Whistleblower, Adulterated Drug Whistleblower, and Pharmaceutical Quality Assurance Whistleblower Lawyer

Health Care Fraud costs United States Tax Payers approximately $90 billion each year through Medicare, Medicaid, and other government health care programs. This has prompted increased law enforcement of fraud against the FDA, Medicare, and Medicaid. This increased enforcement by FDA and the offer of large economic incentives to drug calibration fraud whistleblowers and safety fraud whistleblowers is expected expose a large amount of pharmaceutical drug calibration fraud and safety fraud.

It is important for pharmaceutical safety and drug calibration fraud whistleblowers to not delay in coming forward with a False Claim Act Qui Tam Action for many reasons. First, by coming forward it can expose drug calibration fraud and drug safety fraud that endangers the lives on men, women, and children. Second, only the first drug calibration fraud whistleblower to file is eligible to be a relator and may make a large recovery for exposing the drug calibration fraud or drug safety fraud. Third, when the fraudulent drug calibration scheme is exposed, the people that kept the fraud secret can sometimes be found liable for criminal activity for not exposing the drug safety fraud that was being committed and be held liable for continuing criminal activity.

Drug Calibration Fraud Whistleblower Lawsuits, Drug Safety Fraud Whistleblower Lawsuits, and Contaminated Drug Whistleblower Lawsuits are becoming more common as Pharmaceutical Quality Assurance Managers, Drug Calibration Specialists, and other Drug Safety Whistleblowers are stepping forward to blow the whistle on adulterated drugs, contaminated drugs, and poorly calibrated drugs that threaten the health and lives of children, women, and men that are taking the drugs.

For more information on Drug Safety Fraud Lawsuits, please go to the following web page on Drug Safety Fraud Whistleblower Lawsuit Information, Adulterated Drug Whistleblower Lawsuit Information, Contaminated Drug Whistleblower Lawsuit Information, and Pharmaceutical Drug Calibration Fraud Whistleblower Lawsuit Information.

Dentist Medicaid Fraud Lawsuits, Dentist Office Medicaid Fraud Whistleblower Lawsuits, Dentist Unnecessary Work Medicaid Fraud Lawsuits, Medicare Upcoding Fraud Lawsuits, Dental Upcoding Medicaid Fraud Lawsuits, & Dentist Double Billing Medicaid Fraud Lawsuits

2010-11-27T20:41:00.000-08:00

Dentist Medicaid Fraud Lawsuits, Dentist Office Medicaid Fraud Whistleblower Lawsuits, Dentist Unnecessary Work Medicaid Fraud Lawsuits, Medicare Upcoding Fraud Lawsuits, Dental Upcoding Medicaid Fraud, Dentist Double Billing Medicaid Fraud Lawsuits, and Dentist Office Qui Tam Whistleblower Lawsuits
by Texas Dentist Medicaid Fraud Whistleblower Lawyer Jason S. Coomer

Dentist Medicaid Fraud is on the rise and it is important that Dentist Medicaid Whistleblowers and Dentist Medicare Whistleblowers come forward and blow the whistle on Dentists that are committing Medicaid fraud and Medicare fraud. These Dentist Medicaid Fraud Whistleblower Lawsuits and Dentist Medicare Fraud Whistleblower Lawsuits can result in large recoveries for not only for the government, but for the brave whistleblower that becomes a successful relator and is able to collect a portion of the recovered money.

Dentist Medicaid Fraud Lawsuits in the News, Dentist Alleged to Have Committed Medicaid Fraud, and Unnecessary Dental Work Medicaid Fraud, Dental Upcoding Medicaid Fraud, and Dentist Office Qui Tam Whistleblower Lawsuits

Several Dentists, Dental Management Companies, Dental Clinics, and Dentist Office Professionals, have been the subject of Dentist Medicaid Fraud Whistleblower Lawsuits and Government crackdowns on Dental Medicaid Fraud and Dental Medicare Fraud. These Dental Medicaid Fraud Whistleblower Lawsuits, Dentist Medicare Fraud Whistleblower Lawsuits, and government crackdowns have uncovered unnecessary dental treatments, dentist Medicaid fraud, Medicaid fraud kickbacks, dental Medicare fraud, and other dental Medicaid fraud that were endangering children and costing taxpayers millions of dollars.

National Dental Management Company Pays $24 Million to Resolve Fraud Allegations Medically Unnecessary Dental Services Allegedly Performed on Children

WASHINGTON - The United States today announced that it has settled False Claims Act allegations against FORBA Holdings LLC, a dental management company that provides business management and administrative services to 69 clinics nationwide known as "Small Smiles Centers." Under the agreement, FORBA will pay the United States and participating states $24 million, plus interest, to resolve allegations that it caused bills to be submitted to state Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid, which is funded jointly by the federal and state governments. FORBA has further agreed to put in place various remedial measures designed to prevent similar unlawful conduct from occurring in the future. The government’s investigation of individual dentists is ongoing, and FORBA is cooperating with that investigation by providing information about dentists who may have violated professional standards.

The United States alleged that FORBA was liable for causing the submission of claims for reimbursement for a wide range of dental services provided to low-income children that were either medically unnecessary or performed in a manner that failed to meet professionally-recognized standards of care. These services included performing pulpotomies (baby root canals), placing crowns, administering anesthesia (including nitrous oxide), performing extractions, and providing fillings and/or sealants.

"We have zero tolerance for those who break the law to exploit needy children," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. "Illegal conduct like this endangers a child’s well-being, distorts the judgments of health care professionals, and puts corporate profits ahead of patient safety."

Assistant Attorney General West praised the collaborative efforts of the federal and state agencies that made this result possible. The Justice Department’s Civil Division and the U.S. Attorneys’ Offices for the District of Maryland, the Western District of Virginia, the District of South Carolina, and the District of Colorado handled these cases. The Civil Division led the nationwide investigation, which was conducted by the Office of Inspector General for the Department of Health and Human Services, the Federal Bureau of Investigation, and the National Association of Medicaid Fraud Control Units.

To resolve the allegations against it, FORBA will pay $24 million, plus interest. The federal share of the civil settlement is $14,285,645, and the states’ Medicaid share is $9,714,355.25. In addition, as part of the settlement, FORBA has agreed to enter into an expansive five-year Corporate Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services. The agreement provides for procedures and reviews to be put in place to avoid and promptly detect conduct similar to that which gave rise to this matter. Specifically, FORBA must engage external reviewers to monitor its quality of care and reimbursement processes. In addition, the chief dental officer must develop and implement policies and procedures to ensure that the Small Smiles clinics provide services consistent with professionally recognized standards of care. FORBA has also agreed to cooperate in the government’s continuing investigation of individual dentists.

"We will not tolerate Medicaid providers who prey on vulnerable children and seek unjust enrichment at taxpayers’ expense," said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. "This settlement reaffirms our commitment to protect the health and well-being of Medicaid beneficiaries and to ensure the integrity of this essential health care program."

"Health care providers must be held accountable when they mistreat patients and overcharge insurers," said Rod J. Rosenstein, U.S. Attorney for the District of Maryland. "We are committed to using our affirmative civil enforcement authority to protect patients from inadequate care and protect governmental health coverage programs from fraudulent charges."

The government’s investigation was initiated by three lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private citizens to sue on behalf of the United States and share in any recovery. These actions are pending in the U.S. District Courts for the District of Maryland, the Western District of Virginia, and the District of South Carolina. As part of today’s resolution, the three whistleblowers will receive payments totaling more than $2.4 million from the federal share of the settlement.

"In this case, FORBA put greed and profits before the well-being of children," said Timothy J. Heaphy, U.S. Attorney for the Western District of Virginia. "It endangered the health and safety of innocent children and defrauded the taxpayer of millions of dollars. Today’s settlement addresses these egregious acts and sends a clear message that Medicaid fraud will be expeditiously addressed by this Department."

This settlement with FORBA is part of the government’s emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Department of Justice has used to recover approximately $2.2 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 have topped $3 billion.

Heartland Dental To Pay $3 Million In Civil Settlement Includes $1.3 Million for DEA Registration Violations

APR 14 -- (Springfield, IL) - An Illinois company that manages dental practices in 12 states and its chief executive officer have agreed to a $3 settlement million to the United Stated and Illinois under terms of two settlement agreements. Heartland Dental, Incorporated, which is headquartered in Effingham, Illinois, and Richard E. Workman, Heartland’s CEO, have agreed to pay $1,650,000 to resolve allegations of improper billing to Illinois Medicaid. In a related settlement, Heartland Dental will pay the U. S. $1,350,000 to resolve allegations that newly hired dentists issued prescriptions prior to registration with the DEA as a means to generate revenue for Heartland.

The $1.3 million settlement will resolve allegations that Heartland Dental allowed newly hired dentists to use the DEA resigration number of other Heartland dentists to issue prescriptions. Under the Controlled Substances Act, a DEA registration number allows healthcare providers, including dentists, to distribute and prescribe controlled substances. The allegation that Heartland misused DEA registration numbers resulted in pharmacies unwittingly submitting claims to Medicaid for invalid prescriptions. There were no allegations the prescriptions at issue were not otherwise medically necessary or that any patients were injured as a result of the prescriptions.

“We take seriously the abuse and misuse of DEA registration numbers in the prescribing of controlled substances,” stated Gary G. Olenkiewicz, Special Agent in Charge of DEA’s Chicago Field Division.

“The DEA appreciates our law enforcement partnership and commitment with the FBI, Illinois State Police, the Illinois Attorney General’s Office, U.S. Dept of Health and Human Services and the United States Attorney’s Office that made this a successful investigation.”

Under terms of a five-year consent decree with DEA, Heartland Dental is prohibited from violating the Controlled Substances Act and agrees to permit DEA investigators to conduct administrative inspections as necessary to confirm compliance with the act without requiring the investigators to obtain administrative inspections warrants.

In addition to the DEA violations, under terms of the settlements, while denying the allegations and legal claims, Heartland resolves allegations that from August 1999 through October 2005, it falsely billed Illinois Medicaid for certain procedures: submitting claims for crown buildups, non-covered services, as restorations and claims for surgical extractions which were or should have been simple extractions.

U.S. Attorney for the Central District of Illinois, Rodger A. Heaton stated, “This multi-million dollar settlement is the latest successful result by our outstanding health care fraud team. We remain committed to work together with our partners to recover monies that have been improperly diverted from Medicare and Medicaid, and where appropriate, seek criminal and civil penalties for those who benefit from the unlawful diversion.”

According to FBI Special Agent in Charge Karen E. Spangenberg, health care fraud investigations are among the highest priority investigations within the FBI’s White Collar Crime Program. The FBI conducts between 2,000 and 3,000 new health care fraud investigations each year, by using resources in both the private and public arenas, through partnerships with various federal state and local agencies.

Heartland Dental will pay $1.65 million to the U.S. and Illinois related to a “whistle blower” qui tam lawsuit filed in 2003 by Lori Jamison under the federal False Claims Act and Illinois’ Whistleblower Reward and Protection Act. These acts permit private citizens to bring lawsuits on behalf of the United States or the State of Illinois and receive a portion of the employee proceeds of any settlement or judgment awarded against a defendant. Ms. Jamison, a former employee of one of Heartland’s predecessor entities, will receive $412,500 as her share of the settlement. Heartland has further agreed to pay Jamison an additional $325,000 for dismissal of additional claims, including expenses, attorney’s fees and related costs.

The investigation and negotiations with Heartland Dental were conducted by the U.S. Attorney’s Office for the Central District of Illinois, the Drug Enforcement Administration, the Office of the Inspector General of the U.S. Department of Health and Human Services, the Illinois State Police Medicaid Fraud Control Unit, the Illinois Attorney General’s Office, and the Federal Bureau of Investigation.

North Carolina Dental Services Chain Pays $10 Million to Resolve False Claims Allegations

WASHINGTON – Medicaid Dental Center (MDC), a privately-owned chain of dental clinics in North Carolina previously known as Smile Starters and Carolina Dental Center, has reached a settlement with the United States and North Carolina to resolve False Claims Act allegations, the Justice Department announced today. Under the agreement, MDC agreed to pay $10,050,000 to resolve allegations that it caused false or fraudulent claims for payment to be presented to the North Carolina Medicaid program by billing for medically unnecessary dental services performed on indigent children.

The United States and the state of North Carolina alleged that MDC and its ownership, including Michael A. DeRose , DDS, P.A., and Letitia L. Ballance, DDS, were liable under the False Claims Act for submitting claims for reimbursement for performing pulpotomies that were not medically necessary. Pulpotomies are considered medically necessary in pediatric dental cases when an infection in a tooth spreads into the pulp chamber of the tooth, requiring the pulp’s removal. This procedure is often referred to as a “baby root canal.”

MDC and its ownership also were alleged to have submitted claims for reimbursement for placing stainless steel crowns that were not medically necessary and for failing to obtain informed consent for all medical procedures and services. The settlement is limited to claims submitted to the North Carolina Medicaid program and does not involve any other states.

“These dentists subjected their child patients to invasive and sometimes painful procedures, often for the sake of obtaining money from the North Carolina Medicaid program,” said Jeffrey S. Bucholtz, the acting Assistant Attorney General for the Department’s Civil Division.

Both Dr. DeRose and Dr. Ballance have been disciplined by the North Carolina Board of Dental Examiners. Both entered into consent orders with the Board on December 8, 2005. Under the terms of these consent orders, each of the dentists agreed not to contest allegations that dentists employed and trained by MDC performed excessive treatment on seven of MDC’s pediatric patients by performing pulpotomies and placing stainless steel crowns when they were not warranted or supported by x-rays or appropriate diagnostic documentation. As part of today’s settlement, the Office of Inspector General for the U.S. Department of Health and Human Services has expressly reserved its exclusion authority against MDC and Drs. DeRose and Ballance.

“Health care professionals who abuse their positions and engage in excessive treatment regimens and excessive billing practices will not be tolerated,” said Gretchen C.F. Shappert, U.S. Attorney for the Western District of North Carolina. “The North Carolina Medicaid Program was not created for self-enrichment. It is a public trust. Individuals who use their professional skills to take advantage of that trust will be investigated and held to account for their actions.”

“This settlement with the Medicaid Dental Center demonstrates the commitment of the Office of Inspector General and our law enforcement partners to protect our Nation’s children,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. “The Medicaid program is intended to assist the most vulnerable Americans and to help ensure that they receive necessary health services, not to unjustly enrich others at the expense of indigent persons.”

The investigation and settlement of the case was conducted by the U.S. Attorney’s Office for the Western District of North Carolina and the Department’s Civil Division, along with the Federal Bureau of Investigation, the U.S. Postal Service’s Office of Postal Inspection, the Department of Health and Human Services Office of Inspector General, and the North Carolina Attorney General’s Medicaid Fraud Investigations Unit.

Dentist Medicaid Fraud Lawsuits, Dental Medicaid Fraud Lawsuits, Medicaid Fraud Dentist Office Federal False Claims Act Whistleblower Lawsuits, Unnecessary Dental Work Medicaid Fraud, Dental Upcoding Medicaid Fraud, and Dentist Office Qui Tam Whistleblower Lawsuits

Dentists, Dental Clinics, Dentist Groups, and other health care professionals that take Medicaid and Medicare payments including Federal Medicaid Benefits and State Medicaid Benefits are becoming more common. These Dental and Orthodontic Groups take payments from federal and state funded programs for providing basic dental services to individuals and families. However, in order to increase profits some of these dental clinics, dental groups, orthodontists, dentists, and orthodontic groups provide false billing statements to the government including double billing, triple billing, billing for services not provided, upcoding, or billing for unnecessary services. This billing fraud is dental Medicaid Billing Fraud, orthodontic Medicaid Billing Fraud, dental Medicare Billing Fraud, and orthodontic Medicare Billing Fraud.

It is important for families with children needing dental care or orthodontic care to be able to obtain these services as well as elderly people to be able to obtain dental care and orthodontic care, but it is also important that health care fraud including Medicare Fraud and Medicaid Fraud are stopped. Dental Medicaid Fraud Whistleblowers, Dentist Medicare Fraud Whistleblowers, Orthodontist Medicaid Fraud Whistleblowers, Orthodontic Medicaid Fraud Whistleblowers, and other Medicare Fraud and Medicaid Fraud Whistleblowers are an essential necessary part of identifying and stopping health care fraud.

Dentist Medicaid Fraud Lawsuits, Dental Clinic Medicaid Fraud Lawsuits, Orthodontist Medicaid Billing Fraud Lawsuits, Double Billing Medicaid Fraud and Unnecessary Dental Work Medicaid Fraud Lawsuits, Dental Upcoding Medicaid Fraud Lawsuits, and Dentist Qui Tam Whistleblower Lawsuits

As Medicaid and Medicare spending increases, some health care providers including dentists and orthodontists are making false claims for services including billing for services not provided, upcoding services, double billing, and providing unnecessary services. As such, it is important for Dentists, Orthodontists, Dentist Office Managers, Orthodontics Office Managers, Medicaid Billing Clerks, Medicaid Coders, and other Dental Professionals to become Medicaid whistleblowers to seek compensation on the government's behalf from companies and people that have defrauded taxpayers out of government money. Qui Tam Dental Medicaid Fraud Whistleblower Lawyer Jason Coomer helps Medicaid Fraud whistleblowers and Medicare Fraud Whistleblowers determine if they may have a viable Dental Medicaid Fraud lawsuit, Orthodontics Medicaid Fraud lawsuit, Dentist Medicare Fraud Lawsuit, or Orthodontic Medicaid Fraud lawsuit.

Medicaid Billing Fraud Lawsuits, Medicare Billing Fraud Lawsuits, and the Increase in Medicare and Medicaid Spending

Medicaid is a public health care problem in the United States that provides health care, dental care, and orthodontic care for eligible individuals and families with low incomes and resources. The Medicaid Program is jointly funded by state and federal governments, but is managed by the states. Medicaid is the largest source of funding for medical and health-related services for people with limited income in the United States and the Medicaid program has been increasing. The fastest growing aspect of Medicaid is nursing home coverage and this is expected to continue as the Baby Boomer generation begins to reach nursing home age.

Unlike Medicare, which is solely a federal program, Medicaid is a joint federal-state program. Each state operates its own Medicaid system. Each state's Medicaid Program must conform to federal guidelines in order for the state to receive matching funds and grants. For many states Medicaid has become a major budget issue as on average the state's matching costs of the Medicaid program is about 16.8% of state general funds. According to CMS, the Medicaid program provided health care services to more than 46.0 million people in 2001. In 2008, Medicaid provided health coverage and services to approximately 49 million low-income children, pregnant women, elderly persons, and disabled individuals. Federal Medicaid outlays were estimated to be $204 billion in 2008. Medicaid payments currently assist nearly 60 percent of all nursing home residents and about 37 percent of all childbirths in the United States. The Federal Government pays on average 57 percent of Medicaid expenses.

Texas Dentist Medicaid Fraud Lawsuits, Texas Dental Medicaid Fraud Lawsuits, Texas Orthodontist Medicaid Billing Fraud Lawsuits, South Texas Medicaid Orthodontic Group Medicaid Billing Fraud, South Texas Medicaid Billing Fraud Whistleblower Lawsuits, Texas Medicaid Fraud Double Billing Lawsuits, Texas Unnecessary Dental Work Medicaid Fraud, South Texas Dental Upcoding Medicaid Fraud Lawsuits, and Dentist Office Qui Tam Whistleblower Lawsuits

The Medicaid program in Texas spend about $10 Billion annually on providing health care benefits to the poor. The Texas Medicaid program includes dental work including check ups, fillings, and braces. Of the Medicaid services provided, it is thought that there is an increasing amount of Medicaid Billing Fraud that could be costing tax payers hundreds of millions of dollars each year.

As such, it is vitally important for Texas Medicaid Fraud Whistleblowers to step up and blow the whistle on Medicaid Billing Fraud. Texas Medicaid Whistleblowers, Texas Orthodontic Medicaid Fraud Whistleblowers, and Texas Dentist Medicaid Billing Fraud Whistleblowers need to step up and blow the whistle to stop this Medicaid Fraud. By filing Texas Dentist Medicaid Fraud Lawsuits, Texas Dental Medicaid Fraud Lawsuits, Texas Orthodontist Medicaid Billing Fraud Lawsuits, South Texas Medicaid Orthodontic Group Medicaid Billing Fraud, South Texas Medicaid Billing Fraud Whistleblower Lawsuits, Texas Medicaid Fraud Double Billing Lawsuits, Texas Unnecessary Dental Work Medicaid Fraud, South Texas Dental Upcoding Medicaid Fraud Lawsuits, and Dentist Office Qui Tam Whistleblower Lawsuits, Texas Whistleblowers can save the Texas and the United States hundreds of millions of dollars and may be able to recover tens of millions of dollars themselves if they are successful relators.

The Increase in Government Health Care Spending including Medicare Spending, VA Spending, Tricare Spending, and Medicaid Spending is creating More Health Care Fraud, Medicare Fraud, Medicaid Fraud, and VA Medical Fraud and the need for more Medicaid Billing Fraud Whistleblower Lawsuits, Medicare Billing Fraud Whistleblower Lawsuits, and other Health Care Fraud Whistleblower Lawsuits

The United States government as well as several state governments are stepping up efforts to crackdown on Health Care Fraud, Medicare Fraud, and Medicaid Fraud that are costing taxpayers hundreds of billions of dollars. These efforts include encouraging Medicaid Fraud Whistleblowers and Medicare Fraud Whistleblowers to come forward as well as setting up task forces that are taking down criminals that are involved in Medicaid Fraud and Medicare Fraud.

Health Care Fraud costs United States Tax Payers approximately $90 billion each year through Medicare, Medicaid, and other government health care programs. Because the Medicare budget, the Medicaid Budget, the VA Budget, the TRICARE Budget, Medicaid Fraud, and Medicare Fraud are continuing to increase each year, it is vitally important that Medicare Fraud Whistleblowers, Medicare Fraud Upcoding Fraud Whistleblowers, Medicare Medicaid Fraud Hospital Whistleblowers, Hospice Medicare Fraud Whistleblowers, and Medicare Medicaid Fraud Nursing Home Whistleblowers continue to step forward and blow the whistle on health care fraud.

For more information on Medicare Fraud and Medicaid Fraud, please go to the following pages on Health Care Fraud, Medicare Fraud, and Medicaid Fraud Health Care Fraud and Abuse Control Program Report and Medicaid Fraud Interagency Coordination Report shows that tens of millions of dollars of Medicaid over payments are made each year. These overpayments are often the results of double billing, false billing, upcoding, and other types of Medicaid Fraud that costs Tax Payers significant amounts of money.

Medicare is Different from Medicaid, but both Medicare Billing Fraud Whistleblowers and Medicaid Billing Fraud Whistleblowers are needed to File Medical Billing Fraud Lawsuits

In 2009, the Medicare program covered an estimated 45 million persons and this number is expected to grow as about 7,000 people a day are reaching retirement age. As millions of people are added to the Medicare budget each year, the cost of the Medicare budget is expected to grow.

The Medicare program consists of four distinct parts which are funded differently:

Part A (Hospital Insurance, or HI) covers inpatient hospital services, skilled nursing care, and home health and hospice care. The HI trust fund is mainly funded by a dedicated payroll tax of 2.9% of earnings, shared equally between employers and workers.
Part B (Supplementary Medical Insurance, or SMI) covers physician services, outpatient services, and home health and preventive services. The SMI trust fund is funded through beneficiary premiums (set at 25% of estimated program costs for the aged) and general revenues (the remaining amount, approximately 75%).
Part C (Medicare Advantage, or MA) is a private plan option for beneficiaries that covers all Part A and B services, except hospice. Individuals choosing to enroll in Part C must also enroll in Part B. Part C is funded through the HI and SMI trust funds.
Part D covers prescription drug benefits. Funding is included in the SMI trust fund and is financed through beneficiary premiums (about 25%) and general revenues (about 75%).[27]

Spending on Medicare and Medicaid is projected to grow dramatically in coming decades. While the same demographic trends that affect Social Security also affect Medicare, rapidly rising medical prices appear to be a more important cause of projected spending increases.

Economic Incentives for Whistleblowers Lawsuits, Government Fraud Lawsuits, and Qui Tam Lawsuits

Qui tam provisions of the False Claims Act are based on the theory that one of the least expensive and most effective means of preventing frauds on taxpayers and the government is to make the perpetrators of government fraud liable to actions by private persons acting under the strong stimulus of personal ill will or the hope of gain.

Dentist Medicaid Fraud Lawsuits, Dentist Office Medicaid Fraud Whistleblower Lawsuits, Dentist Unnecessary Work Medicaid Fraud Lawsuits, Medicare Upcoding Fraud Lawsuits, Dental Upcoding Medicaid Fraud Lawsuits, Dentist Double Billing Medicaid Fraud Lawsuits, and Dentist Office Qui Tam Whistleblower Lawsuits

Through Federal False Claims Act Whistleblower Lawsuits, Qui Tam Lawsuits, and other Government Fraud Lawsuits, hundreds of billions of dollars have been recovered from fraudulent government contractors that have stolen large amounts of money from the government and taxpayers. Included in the heroes that have helped recover large amounts of money for taxpayers are Whistleblowers that have recovered billions for themselves and a growing number of dentist Medicaid fraud whistleblowers.

It is extremely important that Whistleblowers continue to expose fraudulent billing practices and unnecessary treatments that cost billions of dollars. For more information on Medicaid Fraud Whistleblowers, Medicare Fraud Whistleblowers, Defense Contractor Fraud Whistleblowers, and other American Hero Whistleblowers, feel free to go to the following web pages: Medicare Fraud, Defense Contractor Fraud, Stimulus Fraud, Government Contractor Fraud, Health Care Fraud lawsuit, Medicare and Medicaid Fraud Lawsuit, Defense Contract Fraud Lawsuit, Government Fraud Lawsuits and Dentist Medicaid Fraud Whistleblower Lawsuits.

Drug Representative Whistleblower Lawsuits, Marketing Executive Whistleblower Lawsuits, & Sales Rep Whistleblower Lawsuits

2010-10-03T16:09:00.000-07:00

Pharmaceutical Representative Whistleblower Lawsuits, Medical Device Representative Whistleblower Lawsuits, Drug Marketing Executive Whistleblower Lawsuits, and Medicare Marketing Fraud Lawsuits

Pharmaceutical representative whistleblowers, medical device sales representative whistleblowers, and drug marketing executive whistleblowers are stepping up and exposing Medicare marketing fraud that is costing taxpayers billions. The economic incentive for these pharmaceutical representative whistleblowers, medical device sale representative whistleblowers, and drug marketing executive whistleblowers is that if they are an original source with special knowledge of fraud and are the first to file, they receive a portion of the money that the government recovers. Depending on the extent of the fraud, qui tam recoveries for the government can be in the billions of dollars and whistleblower recoveries can be in the hundreds of millions of dollars.

Original and Specialized Information of Fraud is Essential for Pharmaceutical Representative Whistleblower Lawsuits, Medical Device Sales Representative Whistleblower Lawsuits, Drug Marketing Whistleblower Lawsuits, and Medicare Marketing Fraud Lawsuits

As insiders, it is common for pharmaceutical representative whistleblowers, medical device sales representative whistleblowers, drug marketing representative whistleblowers, and other marketing executives to have specialized knowledge of marketing fraud and fraudulent marketing schemes. As such, it is important for the pharmaceutical representative whistleblower, medical device sales representative whistleblower, drug marketing representative whistleblower, or other marketing executive whistleblower to obtain and preserve evidence of the marketing fraud. Whether this evidence is in e-mail messages, memos, marketing plans, marketing materials, recordings, or other documents, it is important for the whistleblower to have evidence of the marketing fraud to present. It is also often helpful to have fellow whistleblowers that can help build the Medicare Fraud or Off-Label Marketing Fraud case.

Being the First to File on the Fraud is Essential for Recovery Under the False Claims Act and can Prevent Potential Criminal Liability in Pharmaceutical Representative Medicare Fraud, Medical Device Sales Representative Medicare Fraud, Drug Marketing Medicare Fraud, and other Medicare Marketing Fraud Lawsuits

It is also essential to not delay in coming forward with a False Claim Act Qui Tam Action as the first whistleblower to file is eligible to be a relator and make a large recovery for exposing the fraud. Additionally, when the fraudulent scheme is exposed, the people that kept the fraud secret can sometimes be found liable for criminal activity for not exposing the fraud that was being committed and further be held liable for continuing criminal activity.

Pharmaceutical Representative Whistleblower Protection, Medical Device Sales Representative Whistleblower Protection, Drug Marketing Whistleblower Protection, and Medicare Marketing Fraud False Claims Act Whistleblower Protections

It is also important to understand potential whistleblower protections under the False Claims Act and to discuss with an attorney how to prepare for potential retaliation or aggressive attacks by the employer or contractor. For more information on this topic please go to the following web page on False Claims Act Lawsuit Whistleblower Protections.

Drug Representative Qui Tam Whistleblower Lawsuits, Pharmaceutical Representative False Claims Act Lawsuits, and Drug Representative False Claims Act Protections (Texas Drug Representative Whistleblower False Claims Act Lawyer Jason S. Coomer)

Drug, pharmaceutical, and medical device representatives can often be the original source of specialized knowledge of Medicare marketing fraud that can result in a successful qui tam claim under the Federal False Claims Act. A successful Medicare false claims act qui tam claim can not only result in a significant recovery for the drug representative whistleblower, pharmaceutical representative whistleblower, or medical device representative whistleblower, but can result in uncovering Medicare fraud, Medicaid fraud, Tricare fraud, and/or VA fraud that could result in millions or billions of dollars being recovered or saved by taxpayers.

Drug Representative Off Label Drug Marketing Medicare Fraud Lawyer, Pharmaceutical Representative Medicare Marketing Fraud Lawyer, and Pharmaceutical Representative Whistleblower Qui Tam Lawyer (Off Label Marketing and Pharmaceutical Whistleblower False Claims Act Law Suits)

Through Medicare Marketing Fraud Whistle Blower Lawsuits, Off Label Medicare Marketing Fraud Qui Tam Lawsuits, and other Medicare Health Care Fraud Lawsuits, hundreds of billions of dollars have been recovered from dishonest pharmaceutical companies, medical device companies, health insurance companies, health providers, individuals and organizations that have committed Medicare health care fraud and stolen large amounts of money from the government.

It is extremely important that pharmaceutical representative whistleblowers, medical device sales representative whistleblowers, and marketing executive whistleblowers continue to expose fraudulent marketing practices, billing practices, and unnecessary treatments that cost hundreds of billions of dollars. A Medicare Marketing Fraud Whistleblower Lawyer can greatly assist the potential whistleblower by helping avoid potential pitfalls in incorrectly reporting the fraud as well as helping prepare the evidence and the whistleblower for what is needed in a Medicare Pharmaceutical False Claims Act Lawsuit, Pharmaceutical Medicare Marketing Fraud Whistleblower Lawsuit, Medicare Medical Product Marketing Fraud Qui Tam Whistleblower Lawsuit, or other Medicare Health Care Fraud Whistleblower Lawsuit.

For more information on pharmaceutical representative whistleblower lawsuits, medical device sales representative whistleblower lawsuits, and drug marketing executive whistleblower lawsuits, please feel free to go to the following webpage Drug Representative Whistleblower Lawsuits, Marketing Executive Whistleblower Lawsuits, & Sales Rep Whistleblower Lawsuits.

Tricare Fraud Whistleblower Law Suits, Medicare Fraud Whistleblower Lawsuits, and VA Fraud Whistleblower Lawsuits (Upcoding Qui Tam Claims, Mischarging for Services Claims, Double Billing Qui Tam Claims, Illegal Kickback Qui Tam Claims, & Other Medical Service Provider Fraud Claims)

2010-02-19T13:54:00.000-08:00

Tricare Fraud Whistleblower Law Suits, Medicare Fraud Whistleblower Lawsuits, and VA Fraud Whistleblower Lawsuits (Upcoding Qui Tam Claims, Mischarging for Services Claims, Double Billing Qui Tam Claims, Illegal Kickback Qui Tam Claims, & Other Medical Service Provider Fraud Claims)

Healthcare fraud costs taxpayers an estimated $100 billion each year. Illegal Kickbacks, Upcoding, Double Billing, False Coding, and fraudulent mischarging of health care services are just a few ways that fraudulent medical providers are able to defraud Medicare, Tricare, the Veterans' Administration (VA), and other government services out of billions of dollars. Heroes including health care administrators, doctors, nurses, and therapists are stepping forward and blowing the whistle on Tricare, the Veterans' Administration (VA), and Medicare billing fraud including manipulation of outlier payments to Medicare, kickbacks, upcoding, or bill padding.
If you are a healthcare professional that is aware of fraud, please become a Tricare, Veterans' Administration (VA), Medicaid, or Medicare Whistleblower. To learn about how to file a Tricare, Veterans' Administration (VA), or Medicare Fraud Qui Tam Lawsuit, feel free to contact Medicare, VA, Tricare Fraud Whistleblower Lawyer Jason Coomer via e-mail message or our submission form about a potential upcoding, illegal kickback, bill padding, double billing, or billing fraud qui tam lawsuit.
Health Care Fraud Upcoding Whistleblower Law Suits (Medicare, VA, and Tricare Upcoding Qui Tam Whistleblower Claims)
Upcoding occurs when a medical service provider intentionally and fraudulently upcodes services to obtain a higher reimbursement than one that is entitled to for the service that was actually provided. In both the Medicare and Medicaid systems a set of billing codes is used by healthcare providers to bill for services. These codes are known as the Healthcare Common Procedure Coding System (HCPCS). A service provider that intentionally uses a higher paying code to fraudulently reflect that a more expensive procedure or device was involved in the patient’s treatment than actually was used or was necessary. A pattern of intentional upcoding treatment can result in large profits for the healthcare provider, but also cost taxpayers millions of dollars.
Upcoding fraud is typically hard to catch without the help of persons with inside information because that Healthcare Common Procedure Coding System (HCPCS) codes are billed electronically and can easily slip through the system. Therefore unless the upcoding is caught through a random audit (approximately 2% of the claims per year are audited), it is up to insiders, informants, heroes, and health care professionals to catch fraudulent upcoding.
Another type of coding fraud is “unbundling”, where bundled related procedures or composite lab tests are run together, but billed separately by the lab or healthcare provider to obtain more compensation. These types of billing fraud also allow healthcare providers and labs to make higher profits by bilking Medicare, Medicaid, and taxpayers out of millions of dollars. These unbundling fraud schemes are also hard to detect without someone that is familiar with the codes and billing.
Qui Tam Whistleblower Plaintiffs have received over $1 Billion in Awards of the over $12 Billion in Recoveries for Exposing Fraud Against the United States Government (Qui Tam Plaintiff Whistleblower Claims)
Medicaid, Tricare, Veterans Administration, Hospice, and Medicare Whistleblowers that provide original source information of schemes to fraudulently take money from our United States government including upcoding, double billing, bill padding, unbundling, and charging for services never provided may recover a portion of the proceeds recovered on the government's behalf. Since 1986, relators have recovered over $1 billion for helping expose fraud against the United States government.
Below is an excerpt from the False Claims Act explaining what types of awards qui tam whistleblowers may recover for being the "original source" of information that is used to successfully expose fraud against Medicaid, Tricare, Veterans Administration, Hospice, Medicare, or another subdivision of the United States Government and recover money from the parties committing the fraud.
(d) AWARD TO QUI TAM PLAINTIFF
(1) If the Government proceeds with an action brought by a person under subsection (b), such person shall, subject to the second sentence of this paragraph, receive at least 15 percent but not more than 25 percent of the proceeds of the action or settlement of the claim, depending upon the extent to which the person substantially contributed to the prosecution of the action. Where the action is one which the court finds to be based primarily on disclosures of specific information (other than information provided by the person bringing the action) relating to allegations or transactions in a criminal, civil, or administrative hearing, in a congressional, administrative, or Government [General] Accounting Office report, hearing, audit, or investigation, or from the news media, the court may award such sums as it considers appropriate, but in no case more than 10 percent of the proceeds, taking into account the significance of the information and the role of the person bringing the action in advancing the case to litigation. Any payment to a person under the first or second sentence of this paragraph shall be made from the proceeds. Any such person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys’ fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.
(2) If the Government does not proceed with an action under this section, the person bringing the action or settling the claim shall receive an amount which the court decides is reasonable for collecting the civil penalty and damages. The amount shall be not less than 25 percent and not more than 30 percent of the proceeds of the action or settlement and shall be paid out of such proceeds. Such person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys’ fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.
Since amendments were made to the Federal False Claims Act in 1986, citizens that have filed suits on behalf of the federal government against government contractors that have participated in defrauding the government have regained over $12 Billion for taxpayers as well as have collected over $1 Billion in qui tam whistleblower awards.
Medicare and Healthcare Fraud Law Suits (Qui Tam Claims)
HEALTH CARE FRAUD CASE NETS RECOVERY OF $1.7 BILLION
HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company) and HCA subsidiaries agreed to pay the United States over $1.7 Billion including $631 million in 2003 for civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs. In 2000, HCA subsidiaries pled guilty to substantial criminal conduct and paid more than $840 million in criminal fines, civil restitution and penalties. HCA will pay an additional $250 million to resolve overpayment claims arising from certain of its cost reporting practices. In total, the government will have recovered $1.7 billion from HCA.
This Qui Tam settlement resolved fraud allegations against HCA and HCA hospitals in nine False Claims Act qui tam or whistleblower lawsuits pending in federal court in the District of Columbia. Under the federal False Claims Act, private individuals may file suit on behalf of the United States and, if the case is successful, may recover a share of the proceeds for their efforts. Under the HCA settlement, the whistleblowers will receive a combined share of $151,591,500.00.
http://www.usdoj.gov/opa/pr/2003/June/03_civ_386.htm
Government Contractor Fraud Qui Tam Whistleblower Lawsuit Information (False Claims Act Whistleblower Qui Tam Action Information)
For more information on Medicare Fraud, Tricare Fraud, Medicaid Fraud, Defense Contractor Fraud, Off Label Fraud, Road Construction Fraud, and other types of False Claims Act Whistleblower Claims, please go to the Qui Tam, Whistleblower, and Federal Federal False Claims Act Information Center.

Tricare, Veterans' Administration, Medicaid, and Medicare Fraud Lawyers and Upcoding Law Suits (False Coding Whistleblower Qui Tam Lawyers)

If you are aware of a large health care company or individual that is defrauding the United States Government, Tricare, Medicare, Veterans' Administration (VA), or Medicare out of millions or billions of dollars, contact Medicare, VA, Tricare Fraud Whistleblower Lawyer Jason Coomer via e-mail message Jason Coomer. As a Veterans' Administration, Tricare, Medicaid, Hospice, and Medicare Fraud Whistleblower Lawyer, he works with other powerful qui tam lawyers that handle large Health Care Government Fraud cases. He works with San Antonio Veterans' Administration Fraud Whistleblower Lawyers, Dallas Medicare Fraud Lawyers, Houston Medicare Upcoding Fraud Lawyers, and other Texas Health Care Kickback Fraud Lawyers as well as with other Medicare and Health Care Fraud Lawyers throughout the nation to blow the whistle on fraud that hurts the United States.

Off-Label Drug Marketing and Off-Label Pharmaceutical Marketing Medicare Fraud Lawsuits

2010-01-18T09:04:00.000-08:00

Off-Label Drug Marketing and Off-Label Pharmaceutical Marketing Medicare Fraud Lawsuits

Off-label marketing is the practice of pharmaceutical marketing professionals creating financial incentives and pressuring doctors to prescribe pharmaceuticals for an unapproved uses. In the United States, the Food and Drug Administration Center for Drug Evaluation and Research (CDER) reviews a company's New Drug Application (NDA) for data from clinical trials to see if the results support the drug for a specific use or indication. If satisfied that the drug is safe and effective, the drug's manufacturer and the FDA agree on specific language describing dosage, route of administration, and other information to be included on the drug's label. More detail is included in the drug's package insert.

The Federal Food Drug and Cosmetic Act (”FDCA”), provides a specific regulation process for the approval of new drugs and new drug formulations intended to be marketed for use in interstate commerce. Under the FDCA, a new drug product cannot be marketed unless the FDA approves the product and determines that it is safe and effective for its intended use. When the FDA approves a drug, it approves the drug only for the particular use for which it was tested, but after the drug is approved for a particular use, the FDCA does not regulate how the drug may be prescribed by doctors. Thus, a drug that has been tested and approved by the FDA for one use only can also be prescribed by a physician for another use, known as off-label. Though physicians may prescribe drugs for off-label usage, the FDA prohibits drug manufacturers from marketing or promoting a drug for a use that the FDA has not approved.

In the past ten years some pharmaceutical marketing departments have found it extremely profitable to market their drug for non-FDA approved uses. The FDA's inability to regulate physicians allowed the drug company marketing departments and drug representatives to set up elaborate schemes to encourage physicians to prescribe drugs for off-label uses including misleading doctors as to the efficacy of a drug for a particular treatment and forms of kickbacks including vacations, conferences, initial free samples, hiring physician's families.

Penalties for Off-Label Drug Marketing and Whistleblower Rewards for Stopping Off-Label Pharmaceutical Marketing

Pfizer has paid a total of $2.75 billion in off-label penalties since 2004 which is a little more than 1 percent of the company’s revenue of $245 billion from 2004 to 2008.

JUSTICE DEPARTMENT ANNOUNCES LARGEST HEALTH CARE FRAUD SETTLEMENT IN ITS HISTORY
Pfizer To Pay $2.3 Billion For Fraudulent Marketing

WASHINGTON – American pharmaceutical giant Pfizer Inc. and its subsidiary Pharmacia & Upjohn Company Inc. (hereinafter together “Pfizer”) have agreed to pay $2.3 billion, the largest health care fraud settlement in the history of the Department of Justice, to resolve criminal and civil liability arising from the illegal promotion of certain pharmaceutical products, the Justice Department announced today.

Pharmacia & Upjohn Company has agreed to plead guilty to a felony violation of the Food, Drug and Cosmetic Act for misbranding Bextra with the intent to defraud or mislead. Bextra is an anti-inflammatory drug that Pfizer pulled from the market in 2005. Under the provisions of the Food, Drug and Cosmetic Act, a company must specify the intended uses of a product in its new drug application to FDA. Once approved, the drug may not be marketed or promoted for so-called “off-label” uses – i.e., any use not specified in an application and approved by FDA. Pfizer promoted the sale of Bextra for several uses and dosages that the FDA specifically declined to approve due to safety concerns. The company will pay a criminal fine of $1.195 billion, the largest criminal fine ever imposed in the United States for any matter. Pharmacia & Upjohn will also forfeit $105 million, for a total criminal resolution of $1.3 billion.

In addition, Pfizer has agreed to pay $1 billion to resolve allegations under the civil False Claims Act that the company illegally promoted four drugs – Bextra; Geodon, an anti-psychotic drug; Zyvox, an antibiotic; and Lyrica, an anti-epileptic drug – and caused false claims to be submitted to government health care programs for uses that were not medically accepted indications and therefore not covered by those programs. The civil settlement also resolves allegations that Pfizer paid kickbacks to health care providers to induce them to prescribe these, as well as other, drugs. The federal share of the civil settlement is $668,514,830 and the state Medicaid share of the civil settlement is $331,485,170. This is the largest civil fraud settlement in history against a pharmaceutical company.

Pharmaceutical Kickback Claims and Pharmaceutical Kickback Lawsuits

The pharmaceutical industry has been extremely successful in making large profits by marketing off-label uses of their drugs. Recently, drug representatives, marketing executives, and other whistleblowers have come forward to expose fraudulent practices ranging from fraudulent pricing issues to sales and aggressive marketing practices. Qui tam pharmaceutical fraud cases are expected to continue well into the future as the penalties for off-label marketing have not been enough to prevent big pharmaceutical companies from making large profits on fraud off-label marketing practices.

Health Care Billing Fraud Law Suits (Fraud Costs Tax Payers and Consumers Hundreds of Billions of Dollars)

Health Care Expenses in the United States have increased to be over Two Trillion ($2,000,000,000,000.00) Dollars each year. This amount continues to rise as many unnecessary procedures and treatments are performed as well as unscrupulous health care provided fraudulently billing for medical services that are never performed committing billing fraud, insurance fraud, double billing, and other health care fraud that costs hundreds of billions of dollars.

From a taxpayer stand point, health care fraud costs taxpayers between $60 billion and $100 billion each year. This cost increases dramatically when you include other forms of health care fraud including insurance fraud and fraud on patients.

Anti-Kickback Claims Against Health Care Providers

In 1972, the United States Congress passed the anti-kickback statute which made it illegal for providers, including doctors, to knowingly and willfully accept bribes or other forms of remuneration in return for generating Medicare, Medicaid or other federal healthcare program business. The federal anti-kickback law's main purpose was to protect patients and federal health care programs from fraud and abuse by curtailing the corrupting influence of money on health care decisions. The legislation prevents payoffs to those who have the power to influence health care decisions. This prohibition removes potential economic incentives that could influence health care providers to refer or recommend medical goods and services that are medically inappropriate, medically unnecessary, of poor quality, or even harmful to a vulnerable patient population. This legislation protects federal health care programs from difficult to detect kickback referrals and services as well as works with other laws to provide incentives for whistle blowers that are aware of medical providers that are wrongfully taking money to benefit from disclosing these unlawful kickbacks.

The Anti-Kickback statute prohibits any person or business entity from making or accepting payment to induce or reward any person for referring, recommending or arranging for the purchase of any item or service for which payment may be made under a federally-funded health care program. The statute prohibits kickbacks, bribes, inducements, rewards, and other economic incentives that induce physicians to refer patients for services or recommend purchase of medical supplies that will be reimbursable under government health care programs.

Health Care Provider claims for reimbursement to federal health care programs for services or medical supplies that are the result of bribes, kickbacks, or other economic incentives are false claims and are subject to potential Federal Health Care Program False Claim Lawsuits including Federal Anti-Kickback Statute Lawsuits, Federal Health Care Program Referral Claim Lawsuits, and Federal Health Care Program Medical Supply Bribery Claim Lawsuits.

Failure of a health care provider to comply with the Anti-Kickback Statute is a precondition to participation in federal health care programs and violations of the Anti-Kickback Statute can result in loss of funding, payments, and reimbursements from Medicare, Medicaid, and other Federal Health Care Programs.

For more on the Anti-Kickback Statute, please go to the following webpage, Whistleblower Anti-Kickback Statute Qui Tam Lawsuits.

Hospital Administrators, Health Care Professionals, Accountants, Benefit Coordinators, Drug Representatives, Marketing Professionals, Physicians as Health Care Fraud and Qui Tam Whistleblowers Stepping Forward to File Health Care Billing Fraud Law Suits (Off-Label Pharmaceutical Whistleblower Qui Tam Law Suits)

Through Whistleblower Lawsuits, Qui Tam Lawsuits, and other Health Care Fraud Lawsuits, hundreds of billions of dollars have been recovered from individuals and organizations that have committed health care fraud and stolen large amounts of money from the government.

It is extremely important that Whistleblowers continue to expose fraud schemes, off-label marketing schemes, illegal kickbacks, fraudulent billing practices and unnecessary treatments that cost hundreds of billions of dollars. If you are aware of a large health care company or individual that is defrauding the United States Government out of millions or billions of dollars, feel free to contact Off-label Pharmaceutical Marketing Fraud lawyer Jason Coomer. For more information on False Claims Act Qui Tam Lawsuits, please go to the following website or webpage.

Medicaid and Medicare Upcoding and Hospital Fraud Whistleblower Claims

2009-11-24T17:50:00.000-08:00

Medicaid and Medicare Upcoding and Fraud Whistleblower Lawsuits (Upcoding Qui Tam Claims, Mischarging for Services Claims, Double Billing Qui Tam Claims, Illegal Kickback Qui Tam Claims, & Other Medical Service Provider Fraud Claims)

Health Care Fraud Upcoding Whistleblower Law Suits (Medicare, VA, and Tricare Upcoding Qui Tam Whistleblower Claims)

Upcoding occurs when a medical service provider intentionally and fraudulently upcodes services to obtain a higher reimbursement than one that is entitled to for the service that was actually provided. In both the Medicare and Medicaid systems a set of billing codes is used by healthcare providers to bill for services. These codes are known as the Healthcare Common Procedure Coding System (HCPCS). A service provider that intentionally uses a higher paying code to fraudulently reflect that a more expensive procedure or device was involved in the patient’s treatment than actually was used or was necessary. A pattern of intentional upcoding treatment can result in large profits for the healthcare provider, but also cost taxpayers millions of dollars.

Upcoding fraud is typically hard to catch without the help of persons with inside information because that Healthcare Common Procedure Coding System (HCPCS) codes are billed electronically and can easily slip through the system. Therefore unless the upcoding is caught through a random audit (approximately 2% of the claims per year are audited), it is up to insiders, informants, heroes, and health care professionals to catch fraudulent upcoding.

Another type of coding fraud is “unbundling”, where bundled related procedures or composite lab tests are run together, but billed separately by the lab or healthcare provider to obtain more compensation. These types of billing fraud also allow healthcare providers and labs to make higher profits by bilking Medicare, Medicaid, and taxpayers out of millions of dollars. These unbundling fraud schemes are also hard to detect without someone that is familiar with the codes and billing.

Qui Tam Whistleblower Plaintiffs have received over $1 Billion in Awards of the over $12 Billion in Recoveries for Exposing Fraud Against the United States Government (Qui Tam Plaintiff Whistleblower Claims)

Medicaid, Tricare, Veterans Administration, Hospice, and Medicare Whistleblowers that provide original source information of schemes to fraudulently take money from our United States government including upcoding, double billing, bill padding, unbundling, and charging for services never provided may recover a portion of the proceeds recovered on the government's behalf. Since 1986, relators have recovered over $1 billion for helping expose fraud against the United States government.

Below is an excerpt from the False Claims Act explaining what types of awards qui tam whistleblowers may recover for being the "original source" of information that is used to successfully expose fraud against Medicaid, Tricare, Veterans Administration, Hospice, Medicare, or another subdivision of the United States Government and recover money from the parties committing the fraud.

(d) AWARD TO QUI TAM PLAINTIFF

(1) If the Government proceeds with an action brought by a person under subsection (b), such person shall, subject to the second sentence of this paragraph, receive at least 15 percent but not more than 25 percent of the proceeds of the action or settlement of the claim, depending upon the extent to which the person substantially contributed to the prosecution of the action. Where the action is one which the court finds to be based primarily on disclosures of specific information (other than information provided by the person bringing the action) relating to allegations or transactions in a criminal, civil, or administrative hearing, in a congressional, administrative, or Government [General] Accounting Office report, hearing, audit, or investigation, or from the news media, the court may award such sums as it considers appropriate, but in no case more than 10 percent of the proceeds, taking into account the significance of the information and the role of the person bringing the action in advancing the case to litigation. Any payment to a person under the first or second sentence of this paragraph shall be made from the proceeds. Any such person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys’ fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.

(2) If the Government does not proceed with an action under this section, the person bringing the action or settling the claim shall receive an amount which the court decides is reasonable for collecting the civil penalty and damages. The amount shall be not less than 25 percent and not more than 30 percent of the proceeds of the action or settlement and shall be paid out of such proceeds. Such person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys’ fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.

Since amendments were made to the Federal False Claims Act in 1986, citizens that have filed suits on behalf of the federal government against government contractors that have participated in defrauding the government have regained over $12 Billion for taxpayers as well as have collected over $1 Billion in qui tam whistleblower awards.

Government Contractor Fraud Qui Tam Whistleblower Lawsuit Information (False Claims Act Whistleblower Qui Tam Action Information)

For more information on Medicare Fraud, Tricare Fraud, Medicaid Fraud, Defense Contractor Fraud, Off Label Fraud, Road Construction Fraud, and other types of False Claims Act Whistleblower Claims, please go to the Qui Tam, Whistleblower, and Federal Federal False Claims Act Information Center or the following webpage on Medicaid and Medicare Upcoding & Fraud Whistleblower Lawsuits (Upcoding Qui Tam Claims, Mischarging for Services Claims, Double Billing Qui Tam Claims, Illegal Kickback Qui Tam Claims, & Other Medical Service Provider Fraud Claims) .

Medicare Fraud and Medicaid Fraud Estimated at about $65 Billion a Year

2009-11-21T12:24:00.000-08:00

Recent estimates from the Federal Government suggest that Medicare Fraud is approaching $50 Billion each year and Medicaid Fraud is approaching $20 Billion each year. As a result of this fraud and the need to reduce medical expenditure, the Federal Government including the United States Department of Justice has been cracking down on Medicare Fraud, Medicaid Fraud, VA Fraud, and other forms of fraud that have been committed against the United States. Not only is the United States Government increasing law enforcement efforts to arrest criminals and requiring stricter documentation to obtain Medicare Payments and Medicaid Payments, but the Federal Government has expanded the Federal False Claims Act and is encouraging qui tam whistleblowers to come forward to report Medicare Fraud and Medicaid Fraud.

Illegal Kickbacks, Upcoding, Double Billing, False Coding, and fraudulent mischarging of health care services are just a few ways that fraudulent medical providers are able to defraud Medicare, Tricare, the Veterans' Administration (VA), and other government services out of billions of dollars. Heroes including health care administrators, doctors, nurses, and therapists are stepping forward and blowing the whistle on Tricare, the Veterans' Administration (VA), and Medicare billing fraud including manipulation of outlier payments to Medicare, kickbacks, upcoding, or bill padding.

For more information on Medicare Fraud, Medicaid Fraud, or other Fraud against the United States, please go to the following websites: Medicare Fraud and Medicaid Fraud Lawsuits and Nursing Home Medicare Fraud Skilled Nursing Facilities (SNF) Lawsuits.

Qui Tam Defense Contractor False Certification Whistle Blower Claim Lawsuits

2009-09-13T18:16:00.000-07:00

Common Types of Defense Contractor Fraud and False Certifications that Lead to False Claims Act Lawsuits

Defense contractor fraud is a common way that government contractors defraud the United States Government and taxpayers out of large amounts of money. Many whistle blowers have been successful in blowing the whistle on fraudulent defense contractors to reveal fraud schemes that put our troops in danger and steal money from the United States. Under False Claims Act litigation billions of dollars are regained from these fraudulent defense contractors. Some common ways defense contractors cheat the government are False Certification of Product Quality, Product Substitution, Cross Charging, False Certification of Services Provided, Charging for Services or Goods not provided, and Violations of the Truth-in-Negotiations Act ("TINA"), and Improper Cost Allocation.

False Certification of Product Quality commonly occurs after a product has been approved for mass production. The original prototypes of a product are typically created with high quality materials and parts including strong metals, seals, plastics, and components. However, after the original prototypes have been tested and approved, some defense contractors use inferior parts and materials to lower costs that make weapons, ships, vehicles, computers, electronics, and other military goods less reliable, weaker, and more prone to not work when needed. The defense contractor that provides a false certification of a product's quality has committed a false certification that may subject the defense contractor to a False Certification of Product Quality False Claims Act Law Suit.

The Defense of Department often requires its contractors to build weapons systems in accordance with very detailed product specifications because quality and reliability are critical with weapons systems and other military equipment. Failure to comply with these specifications and falsely certifying that these specifications were met can cause death and place our troops in danger. As such it is extremely important that appropriate quality assurance steps are taken in building or producing weapons systems and other military equipment and that a defense contractor's certification of compliance with these specifications can be trusted.

Similar to False Certification of Product Quality Qui Tam Claims are Product Substitution False Claims. These claims occur when a Defense Contractor that is under a government contract that specifies that the defense contractor build products using a certain grade, quality of parts, or materials & parts from American companies, fails to comply with the contract. These Defense Contractors often decide it is more profitable to use or substitute inferior parts or parts not made by American companies. Defense Contractors that use inferior parts or parts not made by American Companies as required by their government contract may be subject to a Product Substitution False Claim Act Law Suit.

Cross-Charging occurs when a Defense Contractor has a fixed-price contract, where the company receives a fixed price for a certain number of weapons no matter how much it costs to produce them and another that is a "cost-plus" contract, where the government pays the company for the cost of making the weapons, plus a percentage of its costs as a profit. In this circumstance the Defense Contractor has an economic incentive to charge the time it spends working on the fixed-price contract (where it gets paid the same no matter how much time it takes) to the cost-plus contract (where it gets paid for its costs plus profit). This may be accomplished by instructing employees to write down on their time cards that they worked on the cost-plus contract when they actually worked on the fixed-price contract. A Defense Contractor that charges fixed price work on a cost-plus contract is creating false claims or false certifications that may subject them to a Cross-Charging False Claims Act Law Suit.

Improper cost allocation false claims are a more subtle version of the cross-charging scheme. In this type of false claim, a defense contractor with government contracts and private commercial contracts fails to spread or allocate their costs fairly among the different jobs. These types of false claims are typically more difficult to detect as the defense contract usually tries to hide the misallocation in indirect costs or bury the misallocations in hard to interpret records. These improper allocation false claims are more common in large contracts where the product has military uses and private uses such as with large aircraft companies. Defense Contractors that deliberately allocate a disproportionate share of indirect or overhead costs to the government for the purpose on increasing there profits may cause themselves to be subject to Improper Allocation False Claims Law Suits, if the correct whistle blower reports the fraud.

When the government wants to purchase highly specialized weapons, military services, or other military equipment, it often is limited to one potential defense contractor because of the specialized need. This limited supply often creates monopoly power in the "sole-source supplier". This creates a problem in making sure that the sole-source supplier does not over charge the government for the good or services that it is supplying to the government. The Truth In Negotiation Act (TINA) requires the Defense Contractor to truthfully disclose all relevant information about its costs to the government in sole-source contract negotiations. Defense Contractors that submit false cost and pricing data to the Defense Department or failure of a sole-source Defense Contractor to provide accurate cost information to intentionally inflate costs to increase profits can cause liability for a violation of the Truth In Negotiation Act and result in a Truth In Negotiation Act Violation False Claims Act Law Suit.

Qui Tam Defense Contractor False Certification Claim Lawsuits, Defense Contractor Fraud Lawsuit Lawyers, and Other Qui Tam Claim Lawsuits

For more information on Qui Tam Claim Lawsuits and Qui Tam False Certification Lawyers, click on the following links: defense contractor false certification claim lawsuits, health care provider claim lawsuits, financial institute claim lawsuits, or other large contractor or subcontractor claim lawsuits.

Whistleblowers, American Heroes, and Qui Tam Claims

2009-09-11T14:39:00.001-07:00

Whistleblowers, American Heroes, and Qui Tam Claims

During the Civil War, corrupt military contractors were defrauding the United States Army out of hundreds of thousands of dollars and putting troops at risk by supplying troops with defective products and faulty war equipment. Illegal price gouging was a common practice and the armed forces of the United States suffered. In response, Abraham Lincoln enacted the Federal Civil False Claims Act. A key provision of the act was known as qui tam.

The abbreviation is from Latin and refers to "a person who files a suit for the king as for himself". Qui tam laws have existed for centuries as deceptive government contractors have been around as long as government contracting has. Qui tam actions allow a private citizen to file a lawsuit on behalf of the U.S. government in an effort to recover losses caused by fraud against the government. The law is an incentive for civilians who know of individuals or companies making false claims for profit to come forward with information. In reward, the "whistleblower" (also known as the relator) shares in any federal revenue recovered.

If you are aware of a defense contractor, highway contractor, large health care company, or other large contractor or subcontractor that is defrauding the United States Government out of millions or billions of dollars, contact Texas Qui Tam Lawyer Jason Coomer.

History of Qui Tam Claims

In 1986 as a result of increased government contractor fraud, Congress amended the False Claims Act in order to make it easier for whistleblowers to file claims against fraudulent corporations and individuals.

The 1986 Amendment defines a "claim" as:

"...any request or demand which is made to a contractor, grantee, or other recipient if the United States Government provides any portion of the money or property which is requested or demanded, or if the government will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded."

The whistleblower's share of recovery is a maximum of 30 percent and the government's prior knowledge of fraud now does not necessarily bar a whistleblower from collecting lost revenue. If the government took over the lawsuit, the relator can "continue as a party to the action." The defendant is also required to pay for the relator's attorney fees. The whistleblower is also protected from retaliatory actions by his or her employer. As a result or the amendment, qui tam lawsuits increased dramatically. Though the amendment was first made fore corrupt defense contractors, the amendment has uncovered billions of dollars in health care fraud.

Anyone who defrauds the government out of revenue can be held accountable under the False Claims Act. Common defendants include defense contractors, health care providers, other government contractors & subcontractors, state and local government agencies, and private universities. Whistleblowers often include current and former employees of the defrauding company, competitors of government contractors and public interest groups.

The False Claims Act was enacted to encourage private citizens to assist the government in the fight against fraud. Often the whistleblower faces an uphill battle as large, powerful corporations or individuals are usually named as defendants. An experienced attorney in qui tam claims may help you gain a percentage of stolen government funds.

Qui tam actions typically revolve around false claims that are either directly or indirectly presented to the Government for "payment or approval." These false claims can be generated through the submission of false bills, records, statements or other representations made to the Government.

There are several types of Qui Tam claims covered under the False Claims Act:

Mischarging or overcharging for goods or services.
Improper price data and the request for payment for services never provided.
Holding government property for fraudulent purposes.
Avoiding payment of a debt to the government because of illegal reasons.
Knowingly providing the government with defective or dangerous products that were falsely certified.
Falsely certifying information for the entitlement of benefits.
Having any false claim paid by the government.

The mischarging case is the most common type of qui tam case filed. Mischarging cases generally involve filing false claims for goods or services that were not provided or delivered. A common mischarging scenario is employee labor charged to a government contract not worked on. Other common mischarging schemes are claims made to the Government for medical services not rendered or for services performed by an attending physician when the service was actually performed by a nurse or other provider that should have been billed at a lower rate.

Another type of case is the false negotiation or defective pricing case that involves the submission of false cost and pricing data to the Government. This scheme, which takes on many forms, involves the submission of false costs or pricing data to the Government during the negotiation of a contract that subsequently results in an inflated contract price.

Other common types of cases involve product and service substitution and false certification of entitlement for benefits. Examples of product and service substitution are falsely certifying that a product meets specifications, false testing schemes such as falsely certifying that reliability testing was conducted and providing an inferior service or product. Examples of false certification of entitlement cases are falsely certifying information for FHA mortgage guarantees and price supports.

Potential heroes that blow the whistle on government fraud and corruption include employees, former employees, high-level executives, sub contractors, general contractors, and people working with major defense contractors, telecommunications companies, and large health care organizations.

Blowing the Whistle on Those that Commit Fraud Against the United States Government, First to File Provisions of the Federal False Claims Act, and Preserving Relator Rights to Share in Recovery of Funds (Qui Tam Federal Government Contractor Fraud Whistle Blower Claims)

If you are a Health Care Administrator, Hospital Administrator, Nursing Home Administrator, Doctor, Coder, Benefit Coordinator, Nurse, Chief Financial Officer, or other health care professional that has knowledge and evidence of a Health Care Provider, Hospice Provider, Nursing Home, Hospital, Medical Supply Company, or other health care contractor or subcontractor that is defrauding Tricare, Medicare, or the United States Government out of millions or billions of dollars, it is important to gather evidence of the fraud and blow the whistle on the fraud.

In blowing the whistle on government contractor fraud, subcontractor fraud, defense contractor fraud, off label drug fraud, patent fraud, health care fraud, Medicare fraud, Tricare fraud, VA fraud, or other fraud against the government, it is typically best to contact a Federal Government Contractor Fraud, Medicare Fraud, Tricare Fraud, and Hospice Fraud Qui Tam Claim Lawyer like Jason S. Coomer and the firms that he works with to help investigate the fraud and pull together a disclosure and complaint to file.

For information on this web site or Qui Tam Whistle Blower Litigation, feel free to contact Medicare Fraud, Tricare Fraud, and Hospice Fraud Qui Tam Claim Lawyer, Jason S. Coomer.