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Aug 9, 2016 by |

San Francisco Whistleblower Attorney: Healthcare Fraud

ATTORNEY NEWSLETTER

Healthcare Providers and Whistleblowers

Numerous cases in recent years have shown the power of whistleblowers to expose corruption, fraud, and misconduct. In the United State, the government has recognized the value of whistleblowers for a long time, and has passed laws enabling and protecting them going back a century and a half. The False Claims Act, created during the Civil War, allows citizens to file lawsuits on behalf of the government when they have information about companies that try to commit fraud against the State. While military contractors and suppliers were originally the main defendants in these qui tam lawsuits, since the introduction of Medicare, healthcare providers have been the major target.

A recent Case in Florida is indicative of many modern False Claims Act suits. An anonymous whistleblower filed a complaint alleging that Health First, a health care system that operates 4 hospitals in Florida, was paying kickbacks to doctors who sent them patients. This is in violation of the Stark Act and the Anti-Kickback Law, which prohibit exactly this type of qui-pro-quo behavior where physicians and mental health providers send patients to institutions they have financial relationships with.

However, in order to qualify as a qui tam lawsuit, fraud has to be committed against the government: for example, a hospital billing Medicare for services provided to patients that were obtained via illegal kickbacks. Fraud of this type can be very difficult for government investigators to uncover themselves, as complicated financial transactions and internal protocols can obscure the nature of the relationship between physicians and healthcare providers. Whistleblowers, however, have a unique advantage in these situations: they are usually employees of these healthcare companies, often in billing or records departments, and have intimate knowledge of how things are done. Their information can often be the chink in the armor that allows federal investigators to begin a full-scale investigation.

If you have information about government fraud being committed by a healthcare provider, pharmaceutical company, or other business, contact the san Francisco Whistleblower attorneys at the Evans Law Firm. We have experience handling SEC and IRS whistleblower cases, as well as qui tam lawsuits. We can be reached for a free initial consultation at (415) 441-8669, or by email at info@evanslaw.com.

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