HOUSTON, TEXAS GOVERNMENT FRAUD/ WHISTLE BLOWER/ QUI TAM ATTORNEYS
In essence, government fraud refers to illegal acts that intentionally divest the government of funds through deception or scams. When the government gets swindled, taxpayers pay the price.
The False Claims Act (FCA) allows any person who discovers that a government contractor or person receiving government funds under a federal program or grant is defrauding the federal government to report it, and then to sue the wrongdoer, following specialized procedures, on behalf of the U.S. government. These whistle blowers are known under the FCA as qui tam relators. In general, the FCA covers fraud involving any federally funded contract or program, with the exception of tax fraud. Some common examples are:
In FCA lawsuits, known as qui tam suits, the government has the right to intervene and join the private citizen's lawsuit. If the government is then able to collect from the fraudulent contractor, the law allows the whistleblower to share in the proceeds. If the government declines, the individual may proceed on his or her own. The FCA also contains an anti-retaliation provision which protects those who make FCA-protected disclosures or file a qui tam suit. Some states have passed similar laws concerning fraud in state government contracts.
Types of Government Fraud
Fraud against the government can take multiple forms. Among the most significant are procurement fraud, false claims, and Medicare/Medicaid fraud.
Procurement and Contractor Fraud
Procurement and contractor fraud are two of the most costly types of government fraud. An example of procurement fraud is a company using bribes to win a contract even when it did not make the lowest or best bid. Other examples of contractor fraud include billing the government for incomplete work, inflating the cost of labor or supplies, and issuing kickbacks.
False Claims and False Statements
The Federal False Claims Act makes it illegal to present a false claim in order to defraud the government, or to conspire to do so. False claims may pertain to Social Security, defense contracts, healthcare company fraud, or other instances in which a company or individual attempts to be paid by the government for an invalid reason. The penalties for government fraud under the False Claims Act are quite harsh. A convict must pay back three times the amount stolen in addition to a civil fine of $5,000 to $10,000.
Qui Tam
The False Claims Act rewards qui tam relators, or whistleblowers, by allowing them to receive a share of the award for cases in which they expose government fraud. Qui tam laws also offer protections for employees who report wrongdoing by their employers. Although most qui tam cases are in the areas of government healthcare or defense fraud, any type of government fraud can be brought to light by a whistleblower.
Medicare/Medicaid/Pharmaceuticals Fraud
Some of the largest government fraud lawsuits have dealt with government healthcare fraud. Medicare and Medicaid fraud occur when healthcare companies overestimate clinical costs, ask for reimbursement for lab tests or procedures that were never performed, or otherwise attempt to defraud the government. Whistleblowers are often the ones to report Medicare fraud.
Violations of Medicare laws and the Medicare Fraud and Abuse Statute also violate the FCA. Hospitals, nursing homes, doctors, home health care agencies, durable goods providers, pharmacies, and laboratories that seek and receive reimbursement for Medicare and Medicaid funds are government contractors subject to the False Claims Act. Some of the ways a health care provider can violate the FCA include:
- knowingly billing for services not rendered;
- misrepresenting the type of goods or services rendered;
- misrepresenting the nature of the patient's illness; failing to provide correct data on annual hospital or nursing home cost reports to the government, if the errors were knowing or intentional; or,
- providing substandard care.
Healthcare workers and families of nursing home or hospital patients should pay particular attention to the services provided. Nursing home patients are particularly vulnerable, as patients cannot themselves investigate or actively pursue whether public Medicare and Medicaid funds have been obtained fraudulently. Not only can vigilance improve the healthcare for patients and loved ones, but it also will help ensure that public Medicare and Medicaid monies are properly spent in accordance with the law and good medical practice.
Pharmaceutical fraud now accounts for the largest FCA recoveries by the U.S. Government and private citizens. There are many financial pressures upon pharmaceutical companies and their employees to ignore federal laws designed to prevent fraud and curb costs, especially with the advent of the Medicare prescription plan. Pharmaceutical fraud can take a variety of forms, such as:
- Charging for drugs not used and returned to pharmacy providers;
- Marketing, promoting, and selling drugs for uses other than those approved by the FDA;
- Marketing drugs to physicians through illegal means, such as providing financial or other incentives, such as expense-paid 'consulting' trips to doctors and providers who participate in drug marketing promotional meetings;
- Charging prices to the government that are higher than the law allows; and
- Providing substandard care.
- Pharmacy-related violations can include the following:
- Partially filling prescriptions, but charging as if a full prescription was provided;
- Providing kickbacks to a medical provider in order to induce the provider to prescribe certain drugs;
- Prescribing unneeded medications, drugs, or treatment;
- Charging Medicare or Medicaid patients a higher rate than others for the same prescription;
- Knowingly providing defective products or services;
- Falsely diagnosing a more severe ailment than the one the patient actually has, known as 'upcoding' a diagnosis, thereby justifying a more expensive drug therapy or other treatment than that which the patient's health really requires;
- Inappropriate changes in patients' prescriptions from one drug to another as a result of kickbacks or for other improper reasons; and
- Falsely reporting drug research grant information to government agencies.
Contact the Houston, Texas law firm of Leger Adkins today by calling 713-574-5558 or toll free 866-719-0427.
