Each year, whistleblowers help the government recover billions of dollars worth of funds that have been defrauded from federal-funded healthcare programs like Medicare and Medicaid. When healthcare providers or organizations seek to obtain undue payments from Medicare, Medicaid, TRICARE, or the VA by filing false or misleading claims, this is considered healthcare fraud and is in violation of the False Claims Act.
Under the False Claims Act, Austin healthcare whistleblowers, usually healthcare workers, who report fraud committed against government-funded programs, including Medicaid or Medicare, are entitled to a percentage of the financial recovery obtained through their qui tam lawsuit. A healthcare fraud lawyer in Austin can be instrumental in helping to ensure your case is successful.
The whistleblower attorneys of Tycko & Zavareei LLP are highly skilled qui tam litigators with a history of success both in private practice and as federal prosecutors. We are passionate about working with whistleblowers in Austin and throughout the country to expose fraud and other illegal activities that hurt American taxpayers. If you have evidence of Medicare or Medicaid fraud, contact us today for a free consultation.
What is the False Claims Act?
Also referred to as Lincoln’s Law, the False Claims Act (FCA) is a federal anti-fraud law authorized by president Abraham Lincoln during the American Civil War. The FCA’s qui tam provision allows private individuals who have evidence of fraud against federally-funded programs to file a qui tam lawsuit against the offender on behalf of the US government. In exchange for a whistleblower’s contributions, the FCA offers whistleblowers protection from employer retaliation as well as a portion of any financial recovery that is made.
What is Healthcare Fraud?
According to the Centers for Medicare & Medicaid Services, nearly $43 billion was lost to Medicare fraud and over $86 billion to Medicaid fraud in 2020. In order to be reimbursed for services provided to Medicare or Medicaid patients, healthcare providers submit claims to these programs detailing what was provided to the patient and medical records to support the claim. When these claims are submitted with false or misleading information in an effort to receive undue payments, it may be a violation of the FCA. Common types of healthcare fraud in Austin include:
- Billing for services, procedures, or supplies that were not provided
- Billing for services, procedures, or supplies that were not medically necessary
- Creating a false diagnosis to justify unnecessary tests or procedures
- Double billing for services or procedures
- Billing each step of a procedure separately as if they were separate procedures, otherwise known as unbundling
- Billing for a more expensive service or procedure than what the patient received, otherwise known as upcoding
- Billing for a brand-name medication when the patient received the generic version
- Violating the Stark or Anti-Kickback laws by receiving kickbacks in exchange for Medicare, Medicaid, TRICARE, or VA business
Why Should I Report Austin Healthcare Fraud?
American’s tax dollars help fund government programs like Medicare and Medicaid. When healthcare providers commit healthcare fraud, it is American taxpayers that ultimately lose billions of dollars. Healthcare fraud also hurts consumers by increasing insurance premiums and subjecting them to unnecessary medical procedures. As a reward for reporting healthcare fraud, the FCA allows whistleblowers to receive between 15 and 30 percent of the total funds successfully recovered through their qui tam lawsuit.
How are Austin Healthcare Whistleblowers Protected?
Many healthcare workers are apprehensive about reporting fraudulent activities they see taking place at work out of fear they will lose their job or otherwise be retaliated against. The FCA prohibits employers from retaliating against employees who become whistleblowers. If you are fired, demoted, suspended, threatened, harassed, or discriminated against because of any whistleblower actions, contact an Austin whistleblower attorney today.
What is the Texas Medicaid Fraud Prevention Act?
The Texas Medicaid Fraud Prevention Act protects and rewards whistleblowers who report fraud against Texas’s Medicaid program. Under Texas’s Medicaid law, offenders may be ordered to pay up to three times the actual damages caused and receive civil fines for each violation.
Healthcare Fraud Lawsuits Near Austin
Qui tam cases brought under the FCA result in the recovery of billions of dollars each year from companies and individuals who commit fraud. Notable Texas healthcare fraud lawsuits include:
- 2015: Citizens Medical Center in Victoria, Texas agreed to pay over $21 million to settle claims regarding referrals and kickbacks. In this case, the three whistleblowers received close to $6 million.
- 2019: Xerox Corporations and its subsidies agreed to pay over $235 million to settle claims that they oversaw the payment of fraudulent dental claims made to Medicaid for over seven years
- 2022: Drug manufacturer Dr. Reddy’s Laboratories (DRL) agreed to pay $12.9 million to settle claims regarding inflated drug prices reported to Texas Medicaid.
How Can an Austin Healthcare Fraud Lawyer Help Me?
Qui tam lawsuits can be complicated, but a qualified healthcare whistleblower attorney will be able to help you navigate the legal process and understand your rights as a whistleblower. A healthcare fraud attorney can help you build a strong case against an Austin company, protect you from retaliation, and fight for the maximum whistleblower reward for your bravery and contributions.
Contact a Healthcare Fraud Lawyer
At Tycko & Zavareei LLP, our qui tam attorneys are committed to helping healthcare whistleblowers uncover fraud. The work we have done on qui tam lawsuits has led to the recovery of over $7 billion, including a $350 million settlement for a healthcare fraud lawsuit involving a pharmaceutical company engaging in kickbacks and referrals.
Austin whistleblowers who report valuable information regarding healthcare fraud could receive a significant financial reward. If you have evidence of healthcare fraud, contact our national whistleblower lawyers today for a free and confidential case review.
