Working in healthcare is a position of public trust – not only between providers and patients, but also for the protection of taxpayer funds. The Medicare system is in place to protect the most vulnerable and ensure that everyone has access to healthcare when they need it, regardless of age, income, or employment status. However, unfortunately, these public funds are often taken advantage of by unscrupulous practitioners and institutions.
In recent years, Atlanta has been home to several major healthcare fraud schemes uncovered by Department of Justice investigations. In August of 2021, a $2 million settlement was reached in a false claims case against a psychotherapy group based in Roswell. In 2020, an Atlanta-based hospice group settled for $1.75 million after multiple counts of submitting false claims to be reimbursed by Medicare and Medicaid.
Atlanta whistleblowers have helped bring these, and many other cases, to light. The brave efforts of Atlanta whistleblowers help protect taxpayer funds, strengthen the healthcare system for those who turn to it in times of need, report unethical providers, and curb fraud and waste. Whistleblowers in Georgia in cases of Medicare fraud may be eligible for financial awards in exchange for their help in reporting attempts to defraud the government. For more information, contact Tycko & Zavareei LLP’s Medicare fraud attorneys in Atlanta for a confidential case evaluation.
Common Examples of Medicare Fraud in Atlanta
As a healthcare worker, you may be an expert in understanding how procedures are billed and reported to Medicare. Oftentimes, employees are the first and best defense against waste and fraud in their respective industries. If you have reasonable suspicions or proof of Medicare fraud, share your concerns with a Medicare fraud lawyer today.
Some common examples of Medicare fraud, as reported by the Centers for Medicare and Medicaid Services (CMS), include but are not limited to:
- Upcoding – charging for more expensive services than were provided
- Unbundling – charging for each service individually when it would be less expensive to group them together
- Kickbacks – offering, soliciting, or paying for referrals between providers, diagnosticians, or pharmaceutical companies
- Collusion – attempts to collaborate knowingly on efforts to defraud the government
- Drug diversion – writing, selling, or altering unnecessary prescriptions so as to sell or use controlled substances for non-medical reasons
- Billing – for unnecessary services or services never rendered or provided
- Prescribing medically unnecessary services to patients in order to bill their insurance
How to Report Medicare Fraud
Speak to a lawyer right away if you have information or reasonable suspicions about Medicare fraud taking place in Atlanta. The most common mistake whistleblowers make is waiting too long to come forward. Once information has already been leaked to the Department of Justice or shared with the press, it becomes ineligible for financial award. More importantly, evidence that could help preserve the truth can be destroyed in the waiting period before someone comes forward. Finally, speaking up can help avoid you yourself becoming implicated in cases of extensive or ongoing fraud and abuse of the system.
Your call to Tycko & Zavareei LLP is confidential. Our attorneys are available to help you navigate the many details of qui tam law, false claims, and Medicare/Medicaid fraud. We can help you understand what kinds of evidence are legally permissible to share as a whistleblower and what kinds are better left alone. Our offices have extensive experience in the field of qui tam law and healthcare fraud and can help you navigate patient confidentiality as well as the complexities of insurance billing.
Rewards for Atlanta Whistleblowers
According to the False Claims Act, whistleblowers who come forward with valuable, private information that leads to the government recouping defrauded funds are eligible to up to 30% of the total award in a successful qui tam case. In cases of Medicare fraud, settlements often amount to millions or even billions of dollars. This leads to substantial financial payouts for those who come forward to launch an investigation.
Federal False Claims Act
The False Claims Act (FCA) was first passed in 1863 by President Lincoln to address rampant defense contractor fraud during the Civil War. It has been amended several times since and is currently one of the strongest tools the government has to prevent Medicare/Medicaid fraud and other attempts to make improper claims on public funds.
Currently, the False Claims Act holds violators accountable for up to three times the damages – known as “treble damages” – for each false claim submitted to the government. In addition, individual financial penalties can be assessed for each false claim. The total sum is linked to inflation and is regularly adjusted.
Georgia False Claims Act
In 2007, Georgia adopted the State Medicaid False Claims Act (GMFCA), which mirrors provisions of the federal False Claims Act. Violations of the GMFCA are considered actionable under state civil law, and penalties are assessed between $5,500 and $11,000 for each false or fraudulent claim, in addition to the imposition of treble damages.
The GMFCA was put in place to protect Georgia Medicaid funds, as well as whistleblowers who come forward with information. Similar to the federal FCA, the GMFCA also prohibits retaliation against employees, or those associated with them, who act in efforts to prevent crime.
Atlanta Whistleblower Protections
Examples of prohibited retaliation against whistleblowers or those who act on their behalf include:
- Firing or suspension
- Demotion
- Reduction of pay or hours
- Threats or harassment
- Changes in employment status related to their disclosure
Contact a Medicare Fraud Lawyer in Atlanta Today
If you have information about Medicare fraud in Atlanta, or if you have faced unlawful consequences as a result of coming forward, you may be eligible for a financial award, backpay, and reinstatement. Speak to a qualified Atlanta Medicare fraud attorney at Tycko & Zavareei LLP today to understand how we can help. Reach out today for a confidential, complimentary legal consultation.
