The False Claims Act (FCA) is a federal law in the United States that allows individuals to bring lawsuits on behalf of the government against individuals and entities that defraud government programs. In the context of healthcare, there are several common schemes that have been subject to FCA enforcement actions. Here are 10 different common
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Bogus Basements and Fake Foundations: The $100 Million Hurricane Katrina Whistleblower Case
Qui tam cases are not limited to healthcare fraud. In fact, the false claims act was originally passed to respond to widespread fraud in the procurement of weapons and materials for the Union Army. The Union Army would contract for horses and get donkeys instead.
Dante’s eighth circle is reserved for fraudsters, and you wouldn’t…
Whistleblower allegations results in real change for patients.
Cigna is paying $172 million after defrauding the United States for years. But that’s not the story here. Cigna is a $90 billion publicly traded healthcare insurer. No one is surprised that it’s engaged in light fraud from time to time. This fine barely makes a dent.
The story here is the whistleblower, Robert Cutler.…
The False Claims Act results in defeat for Victory.
The details can be complicated, but identifying fraud is pretty straightforward. It’s a lie told for money. Pretty simple.
And it doesn’t get much simpler than this scheme to defraud the government out of over $6 million.
During the pandemic, the government gave out lots of money through the Paycheck Protection Program. Billions and billions…
Qui Tam CLE
I’ll be presenting on qui tam issues that we discuss here on November 15. Come by and check it out!
It’ll be at our firm, Markowitz Herbold, 1455 SW Broadway, Ste 1900. Come by and let’s talk whistleblowing and qui tam. Ok, ok, I’ll even throw in lunch, but that’s my best and final offer.…
The qui tam laws protect whistleblowers
Qui tam provisions, rooted in the False Claims Act (FCA) of 1863, are legal mechanisms designed to encourage private individuals to report fraud committed against the government. These individuals, known as qui tam whistleblowers, can be employees, contractors, or anyone with inside information about fraudulent activities, especially in sectors like healthcare, defense, and finance.
Protections…
What is qui tam
The United States government contracts with vendors to provide goods and services. For example, through Medicare and Medicaid, the federal government contracts with hospitals, medical groups, and doctors to provide health care services to about 37% of the population.
Qui tam laws help to fight fraud in government programs. A qui tam action, derived from…
SEC Whistleblower Program
The U.S. Securities and Exchange Commission (SEC) whistleblower program is a crucial initiative designed to encourage individuals to report violations of federal securities laws, thus promoting transparency and integrity in financial markets. Established as part of the Dodd-Frank Wall Street Reform and Consumer Protection Act in 2010, this program represents a significant milestone in the…
Urine Trouble
This one is pretty straightforward. Doctor owns pain clinic. Incidentally, that’s should be the first red flag.
Doctor also owns an in-house lab to test urine. That lab doesn’t really do any other business–it would fail unless doctor sends it urine to test. Second red flag. So, that’s what the doctor does. It doesn’t matter…
Hearts for hire
Here’s the situation. You provide a service and that service is valuable–it might even save someone’s life. Luckily, that service can also make you a lot of money. Like millions of dollars a year. But you need people for your service. That service is a health care service, so let’s call those people patients.
You’re…