With millions of Americans insured through Medicare, Medicaid or other government programs, health care is an increasingly tempting area for fraud. Fraudulent claims for health care services cost the government billions of dollars every year, and is a major reason for the increase in health care costs in the U.S.
The government prosecutes those who commit health care fraud under the False Claims Act and the U.S. Department of Justice operates a Medicare Fraud Strike Force to search out and prosecute individuals accused of health care fraud. Texas also has its version of the False Claims Act, known as the Texas Medicaid Fraud Prevention Act.
The FCA has provisions that protect whistleblowers — individuals who report health care fraud crimes — and allow those whistleblowers to sue individuals or institutions that engage in health care fraud on behalf of the government. This is known as a qui tam lawsuit. Whistleblowers are eligible to receive a portion — typically between 15-25% — of any recovered funds.
Whistleblowers are protected by the FCA against being fired, demoted, suspended or threatened by employers as a result of filing an FCA complaint. If an employer is found to have retaliated against a whistleblower, they may be liable for back pay, interest and any other compensation due as a result of damage or loss the whistleblower may have suffered as a result of filing an FCA claim.
According to the U.S. Department of Justice, there was more than $3.5 billion in settlements and judgments obtained against individuals and companies for health care fraud in 2015. Whistleblowers were awarded a total of $597 million in claims.
Qui tam litigation is a highly technical, complex area of the law. If you are considering filing a qui tam action, you should choose an attorney with the experience and resources to see your case through to the end.
If you or a loved one has suffered an injury or injustice, the experienced personal injury legal team at Roberts & Roberts is here to help with compassionate, aggressive representation. Please call 800-248-6000 or contact us for a free consultation.
Justin is an attorney at Roberts & Roberts and focuses his practice on mass tort litigation, where he specializes in helping individuals who are harmed by recalled or unsafe pharmaceutical drugs and medical devices. He has earned recognition as a “Top 40 Under 40” Trial Lawyer by the National Trial Lawyers. Prior to joining Roberts & Roberts, Justin served as an attorney in all three branches of Texas’s state government, including as a Briefing Attorney on the Texas Supreme Court. He also represented electric and natural gas utilities in complex regulatory proceedings before the Public Utility Commission of Texas and the Railroad Commission of Texas. Justin is a published author in the St. Mary’s Law Journal.