Healthcare Fraud Lawyer Blog

July 20, 2018

Four Step Guide to Whistleblowing

samson-duborg-rankin-91091-unsplash-copy-300x200 If you suspect that your employer or another organization is committing fraud, financial mismanagement, unethical practices, or other illegal activities, you have a right to report that illegal activity as a whistleblower. This four step guide to whistleblowing will explain the exact steps you need to take to successfully report a whistleblowing case.

Hire a good lawyer, fast. The first thing you will want to do is hire an experienced whistleblower attorney as soon as you detect the organization’s illegal activities. While you may be tempted to report the illegal activity internally, many organizations will do anything they can to mask internal misconduct and will defend the company at your expense. Even though whistleblower retaliation is prohibited under federal OSHA laws and the California False Claims Act, it is not unheard of for employers to fire or mistreat their employees who have been discovered to be whistleblowers.

An experienced attorney, on the other hand, can give you advice as to exactly what you should be doing to gather evidence and build a strong case, without risking your job security. While a lawyer will be your best support in filing a whistleblower case, it is still your job to collect all the necessary evidence. A whistleblower case is not based on hunches alone but on hard, solid evidence.

July 13, 2018

How Whistleblowers can Help Stop Insurance Fraud

by Gregory J. Brod

hush-naidoo-382152-copy-300x200 Insurance fraud can take place across multiple industries, from automobile insurance to medical insurance to property insurance. In most cases, the victim does not even know that he or she has been defrauded. By making yourself aware of common insurance fraud schemes in California, you can better equip yourself to identify insurance fraud when it occurs and help stop insurance fraud in California. If you believe you have witnessed an incident of insurance fraud, call Brod Law Firm at (800) 427-7020 today to speak with an experienced qui tam attorney and learn how you can help.

What is Insurance Fraud?

The California Penal Code defines insurance fraud as the willful injury, destruction, or disposition of any property that is insured against loss or damage. Consumers and businesses alike can be guilty of insurance fraud. While a consumer might be found committing insurance fraud by submitting a claim to his or her insurance company based on false injuries, a business might be found committing insurance fraud by inflating the cost of their services or billing for services that were never performed. While insurance fraud can take place in just about any industry, the most common industries in which insurance fraud is seen are the automobile, healthcare, workers’ compensation, property insurance, and life insurance industries.

July 6, 2018

What You Should Know About Whistleblower Retaliation in California

by Gregory J. Brod

benjamin-child-90768-300x200 Many employees are afraid to report their employer’s illegal conduct in fear that they will be terminated or punished in some way. However, California law prohibits whistleblower retaliation against an employee and offers restitution for those who have been victims of whistleblower retaliation. If you have been the victim of whistleblower retaliation in California, contact our experienced San Francisco whistleblower attorneys at (800) 427-7020 immediately for your free case evaluation.

What is Whistleblower Retaliation?

Whistleblower retaliation in the workplace can look similar to other forms of workplace retaliation. However, whistleblower retaliation refers specifically to retaliation against employees in response to employees’ reporting of his or her employer’s illegal actions or improper conduct. Whistleblower retaliation can take the form of wrongful termination, demotion, denial of resources and training, negative performance reviews, increase in work hours, and more. California whistleblower laws extend these protections to contractors and agents in addition to employees.

June 29, 2018

Seven Common Health Care Fraud Schemes

by Gregory J. Brod

ken-treloar-385255-copy-300x200 It is illegal in California to commit health care fraud, yet with the confusing payment bureaucracy for health care in the United States, health care fraud occurs more frequently than most people think. Health care fraud, also known as medical insurance billing fraud, health insurance fraud, Medicare fraud, Medi-Cal fraud, or HMO fraud, takes the form of many different types of improper and illegal actions. By familiarizing yourself with the most common types of health care fraud schemes, you may be able to identify if and when your health care provider is committing health care fraud. If you have information regarding improper billing or other types of health care fraud from your health care provider, call Brod Law Firm at (800) 427-7020 today to speak with an experienced health care fraud attorney and learn more about your rights and remedies today.

Seven Common Health Care Fraud Schemes

Billing for services that were never performed

June 20, 2018

Violations of the Stark Law can Form the Basis of FCA Lawsuits

by Gregory J. Brod

ken-treloar-385255-copy-300x200 The False Claims Act (FCA), which prohibits entities that conduct business with the government from defrauding the government, goes all the way back to the time of the Civil War. It is sometimes called the Lincoln Law because of the president who was in office when the law went into effect.

Since the advent of Medicare and Medicaid, physicians and hospitals fraudulently obtaining payments from publicly funded healthcare programs have been defendants in many FCA lawsuits. Often the violation is not as simple as doctors submitting claims to Medicare for services they did not perform, although such fraudulent claims certainly do constitute FCA violations. Likewise, some FCA violations occur when doctors perform unnecessary procedures (for example, performing a surgery when the patient’s condition could be adequately managed with medication) just to be able to bill Medicare for them. It can even be an FCA violation if a doctor benefits financially from referring a Medicare or Medicaid patient for other services. If you are a healthcare worker and have evidence that your workplace has intentionally benefited financially from referrals made at the expense of Medicare or Medicaid, filing a qui tam lawsuit could offer you legal and financial protection while also protecting patients and taxpayers from fraud.

The Stark Law

June 12, 2018

Department of Justice Intervenes in California FCA Lawsuit Against Pharmaceutical Company

by Gregory J. Brod

jonathan-perez-409943-copy-300x200 Ever since the passage of the Affordable Care Act in 2010, all violations of the Anti-Kickback Statute (AKS) have been actionable under the False Claims Act (FCA). In plain language, this means that, if you are aware that people in your workplace are defrauding government agencies, you can file a qui tam lawsuit, also known as a whistleblower lawsuit, on behalf of the government. California has become the most recent state in which the Department of Justice (DOJ) has taken legal action against a pharmaceutical company that, according to whistleblowers, engaged in fraudulent practices related to the marketing and promotion of an addictive drug.

The Drug, the Pharmaceutical Company, and the Fraudulent Activities

The drug at the center of the controversy is an analgesic mouth spray; the FDA has approved the drug only for the treatment of breakthrough cancer pain. Breakthrough pain, a phenomenon common in cancer patients, is when a patient is able to control his or her chronic pain through consistent use of medication but occasionally also suffers acute pain (“breakthrough pain”) that requires additional medication. Thus, the approved uses for the drug were quite narrow. Despite this, the pharmaceutical company allegedly engaged in several prohibited practices in order to entice physicians and nurse practitioners to prescribe the drug for patients other than those for whom it was intended. Whistleblowers reported the following AKS violations on the part of the drug company.

June 7, 2018

Healthcare Fraud is Widespread, but Whistleblowers can Help Stop it

by Gregory J. Brod

ken-treloar-385255-copy-300x200 Medicare and Medicaid are taxpayer-funded healthcare programs instituted for the purpose of ensuring that all Americans have access to basic health services. Fraud on the part of health care providers is a major threat to these programs and to the health of millions of Americans who benefit from their services. Every year, physicians and other members of the healthcare industry enrich themselves by diverting funds from Medicare and Medicaid to themselves and by fraudulently billing these publicly funded programs. Whistleblowers who have helped bring legal action against purveyors of healthcare fraud have helped the nation recover billions of dollars for healthcare. If you are aware of healthcare fraud at your workplace, contact an attorney to discuss filing a qui tam lawsuit.

How Big a Problem is Healthcare Fraud?

The Department of Justice collects data on healthcare fraud, and the figures are alarming. For 2014, the most recent year for which the DOJ has published statistics, it is clear that healthcare fraud was widespread, but that the government, with the help of whistleblowers, was taking effective measures to stem it.

May 30, 2018

Authorities Uncover $20 Million Health Care Scheme in California

by Gregory J. Brod

piron-guillaume-96228-copy-300x200 Federal authorities arrested five individuals connected to San Fernando Valley clinics and a significant health care fraud scheme. On May 22, a federal grand jury indictment was unsealed. The indictment alleges that the five individuals engaged in a health care fraud conspiracy over multiple years and targeted at least eight health insurance companies and the International Longshore and Warehouse Union, the Pacific Maritime Association Benefit Plan, and the Federal Employees Health Benefits Program.

The Conspirators

According to the Department of Justice (DOJ) press release, the co-conspirators included:

May 25, 2018

The Anti-Kickback Law

by Gregory J. Brod

aidan-bartos-313782-copy-300x200 One of the ways in which physicians and other health care professionals commit fraud against the federal government is through accepting or providing illegal payments or gifts to generate certain business. This type of scheme is also known as kickbacks.

One of the most common kickback schemes associated with this field is paying a health care professional for referrals to a certain physician, facility, or medical device provider. The person or place that receives the referral is then able to use the new business to grow their claims to a federal health care program and unlawfully increase their reimbursements. In many cases, the services or products they bill for are medically unnecessary or fraudulent in another way. However, not all kickback schemes involve referrals. Payments or gifts intended to generate any health care business, which is then unlawfully invoiced to Medicare or Medicaid for reimbursement, is illegal.

If you know of a physician or other health care professional who is paying or accepting kickbacks that lead to false claims against Medicare or Medicaid, contact a San Francisco anti-kickback lawyer from Brod Law Firm today. The information and evidence you have may be enough for you to file a qui tam case under the False Claims Act against those participating in the fraudulent scheme.

May 25, 2018

Lance Armstrong Settles FCA Violation Claim

by Gregory J. Brod

howard-lawrence-b-652037-unsplash-copy-300x169 The U.S. Department of Justice (DOJ) announced that Lance Armstrong, a former professional cyclist, has agreed to pay the U.S. $5 million to resolve a whistleblower lawsuit regarding allegations that he violated the False Claims Act (FCA) by using performance-enhancing drugs and methods (PEDs) while sponsored by the U.S. Postal Service (USPS).

If you are aware of a professional athlete or team violating a federal or state government sponsorship agreement, contact a San Francisco qui tam attorney at Brod Law Firm.

Armstrong’s Doping Case