Whistle Blower Lawsuits

Whistle Blower

The federal government gets defrauded every day by huge corporations and by members of the healthcare industry. The Federal False Claims Act (codified at 31 U.S.C. 3729-3733) was created to help catch those who seek to cheat the government. These false claims are known in legal circles as qui tam (whistleblower) cases.

The government relies upon employees in private companies to step forward and “blow the whistle” when they see fraudulent activity. Whistleblowers are then entitled to receive a percentage of the money recovered, usually between 15 and 25 percent.

Under the False Claims Act, those who knowingly submit, or cause another person or entity to submit, false claims for payment of government funds are liable for three times the government’s damages plus civil penalties of $5,500 to $11,000 per false claim. Litigation costs and whistleblower awards are paid for by the triple damage penalties. The Act has recovered nearly $26 billion since 1986.

Some Types of False Claims Uncovered to Date

Billing Fraud

  • Charging for products and services that were never delivered or rendered
  • Unbundling – Using multiple billing codes instead of one billing code for a drug panel test in order to increase remuneration
  • Bundling -- Billing more for a panel of tests when a single test was asked for
  • Double billing – Charging more than once for the same goods or service
  • Upcoding – Inflating bills by using diagnosis billing codes that suggest a more expensive illness or treatment
  • Billing for brand -- Billing for brand-named drugs when generic drugs are actually provided
  • Upcoding employee work – Billing at doctor rates for work that was actually conducted by a nurse or resident intern
  • Billing in order to increase revenue instead of billing to reflect actual work performed
  • Billing for work or tests not performed
  • Billing for research that was never conducted
  • Charging for advertising, lobbying or other non-contract-related business activities

Medicare/Medicaid Fraud

  • Performing improper or unneeded medical procedures in order to increase Medicare reimbursement
  • Forging physician signatures when such signatures are required for reimbursement from Medicare or Medicaid
  • Billing for unlicensed or unapproved drugs
  • Automatically running a lab test whenever the results of some other test fall within a certain range, even though the second test was not specifically requested
  • "Lick and stick" prescription rebate fraud and "marketing the spread" prescription fraud, both of which involve lying to the government about the true wholesale price of prescription drugs

Fraudulent Records

  • Submitting false service records or samples in order to show better-than-actual performance
  • Falsifying natural resource production records -- Pumping, mining or harvesting more natural resources from public lands that is actually reported to the government
  • Defective testing – Certifying that something has passed a test, when in fact it has not
  • False certification that a contract falls within certain guidelines (e.g. the contractor is a minority or veteran).
  • Phantom employees and doctored time slips – Charging for employees that were not actually on the job, or billing for made-up hours in order to maximize reimbursements
  • Falsifying research data that was paid for by the U.S. government

Equipment Fraud

  • Presenting faulty or unproven equipment as operational and tested
  • Billing for premium equipment but actually providing inferior equipment

Product Fraud

  • Misrepresenting the value of imported goods or their country of origin for tariff purposes
  • Failing to report known product defects in order to be able to continue to sell or bill the government for the product

Miscellaneous

  • Yield burning -- skimming off the profits from the sale of municipal bonds
  • Being over-paid by the government for sale of a good or service, and then not reporting that overpayment
  • Obtaining a contract through kickbacks or bribes
  • Prescribing a medicine or recommending a type of treatment or diagnosis regimen in order to win kickbacks from hospitals, labs or pharmaceutical companies

Coxwell & Associates is now investigating healthcare fraud cases, specifically involving hospice facilities. If you are an employee at a hospice facility and have witnessed any type of fraudulent Medicare or Medicaid billing, please contact Chuck Mullins at Coxwell & Associates. You may be entitled to a percentage of any amounts recovered.

We will also look at any other type of government fraud cases. Coxwell & Associates is a Mississippi law firm located in Jackson, Hinds County Mississippi. We handle serious cases all over the state.

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