Healthcare Fraud on the Government
The Three Pillars of Government Enforcement and Prevention
Healthcare fraud against Medicare and other government health care programs amounts to billions of dollars every year. Whistleblowers initiate the majority of enforcement and recovery actions and typically bring their cases under three enforcement laws: the False Claims Act, the Stark Law, and the Anti-Kickback Statute. The government rewards whistleblowers for up to 30% of amounts recovered in actions brought under these laws. The California and San Francisco whistleblower attorneys at Evans Law Firm, Inc. represent whistleblowers with information regarding violations of these statutes by a variety of healthcare providers including pharmaceutical companies, skilled nursing facilities, medical device manufacturers, labs, clinics, hospitals, and physician groups. If you have credible information for a healthcare fraud whistleblower case or any other whistleblower case in California, call us today at (415)441-8669 and we can help.
The False Claims Act (“FCA”), 31 U.S.C. § 3729
The FCA permits recovery of funds from anyone who knowingly presents or causes to be presented a fraudulent claim for payment to the government. To establish FCA liability, a whistleblower must show that a defendant knowingly submitted or caused to be submitted a false claim for payment or reimbursement to the government. The FCA prohibits use of any false statement or document in support of a claim for government funds. Liability under the FCA is also allowable for violations of the Stark Law and the AKS.
The Stark Law, 42 U.S.C. § 1395nn
Stark—named for former U.S. Congressman Pete Stark (D-CA) who sponsored the bill—prohibits physicians from referring a patient to a medical facility in which the referring physician has a financial interest. Violations are subject to a strict liability standard, and enforcement extends to most any type of remuneration within the Medicare system for patient referrals. Penalties under Stark include recovery of payments made in violation, imposition of a $15,000 per service penalty for knowing violations, and a monetary fine of $100,000 for each arrangement found to have willfully circumvented the law.
The Anti-Kickback Statute (“AKS”), 42 U.S.C. § 13201-7b
The AKS prohibits anyone from offering, paying, soliciting, or receiving remuneration (cash or gifts, vacations, speaking fees, etc.) to induce referrals or generate business for any program that that receives federal funds. Civil monetary penalties of up to three times each kickback and $50,000 per violation may be awarded; criminal penalties also apply. Recent amendments to the AKS make violations also actionable under the FCA, even if the service was medically necessary and properly provided.
We recommend you call an attorney before alerting the government with information regarding any violations of these statutes. In addition to healthcare fraud whistleblower cases, our attorneys also handle whistleblower cases before the Internal Revenue Service (IRS) for offshore tax avoidance schemes, and securities fraud whistleblower cases before the Securities and Exchange Commission (SEC) and Commodity Futures Trading Commission (CFTC). If you or a loved one has information regarding false claims in San Francisco or elsewhere in California, 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=”mailto:firstname.lastname@example.org”>email@example.com</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.