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Oct 30, 2018 by |

California and San Francisco Whistleblower Attorney: Healthcare False Claims Act Cases


Large Whistleblower Settlement For Illegal Upcoding

False claims for inflated Medicare reimbursements (sometimes in the form of “upcoding”) are a common fraud against the government. Under the False Claims Act, whistleblowers initiate the majority of recovery actions against companies for submitting such inflated claims. The California and San Francisco whistleblower attorneys at Evans Law Firm, Inc. represent whistleblowers with information about inflated claims for reimbursement and other false claims for government reimbursement made by pharmaceutical companies, medical device manufacturers, labs, clinics, hospitals, physician groups and others.  If you have credible information of false claims or any other whistleblower case in California, call us today at (415)441-8669 and we can help.

The cases and whistleblower awards are often large. Some cases involve “upcoding,” where a healthcare provider assigns diagnosis codes to patients that do not reflect their real medical condition but generate higher reimbursement levels from government programs.  The Department of Justice (DOJ) recently settled an “upcoding” whistleblower suit for $270 million against a provider that allegedly submitted false diagnosis codes to Medicare resulting in inflated reimbursements.[1]  A whistleblower at a company doing business with the provider had original information that the company routinely miscoded patient conditions in order to receive these higher reimbursement rates.  False claims often involve upcoding schemes such as this one, or overbilling, kickbacks for referrals, and faulty drug and device sales to boost their bottom line at the expense of the government and taxpayers.

If you have original information of this kind of fraud, as a whistleblower you may be entitled to receive up to 30% of amounts recovered. But you need the advice of counsel to protect your chances at a reward. Don’t make any calls to the government about your information until you have consulted with counsel. To be eligible for a reward under the False Claims Act and other whistleblower programs you must report the fraud through appropriate and timely court filings or an application addressed to the appropriate office of the applicable government agency or court.  This is where our California whistleblower attorneys can help.  Our attorneys know the appropriate procedures for your type of allegation and know how to organize and present your credible, original information and documentation in the most effective way toward securing an eventual reward.  The law may also protect you if your employer retaliates against you for your whistleblowing and our attorneys can represent you in any action for wrongful termination as well as in your underling whistleblower case.  

Contact Us

If you or a loved one has information regarding false claims in San Francisco or elsewhere in California under Medicare or Medicaid or any other government program, offshore tax avoidance schemes against the IRS, or securities fraud in violation of SEC and CFTC regulations, contact Ingrid M. Evans and the other Evans Law Firm whistleblower and false claims attorneys at (415) 441-8669, or by email at <a href=””></a>. Our attorneys have experience with complex financial contracts and large insurance companies. We can help guide your case through a jury trial or toward an equitable settlement.  We handle cases involving financial elder abuse, whole life insurance and universal life insurance, and indexed, variable, and fixed annuities.

[1] Evans Law Firm, Inc. was not involved in the case.  The company denied any wrongdoing in the $270 million settlement.

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