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What is a Qui Tam Relator?

The simplest answer is that, in False Claims Act (“FCA”) cases, the relator is the whistleblower who brings the FCA claims against the company or individual who is committing fraud. Usually a qui tam relator is an insider—typically a current or former employee—who has access to confidential information showing that his or her employer [...]

By | 2019-05-13T11:15:48+00:00 February 21st, 2019|False Claims Act Information|

Tennessee Whistleblower Law

The Tennessee False Claims Act  (“Tennessee FCA”) mirrors the federal False Claims Act (“FCA”), but it involves claims made to state and local governments in Tennessee, as opposed to the federal government. The Tennessee Medicaid False Claims Act (“Tennessee Medicaid FCA”) applies to any false claims made to Tennessee’s state Medicaid program. The Tennessee [...]

By | 2019-03-27T12:45:20+00:00 February 6th, 2019|False Claims Act Information|

Medicaid Fraud

Medicaid pays for approximately 20% of all healthcare expenses in the United States, over $600 billion each year. Well over 500,000 healthcare providers, ranging from hospital chains to individual doctors to ambulance helicopter pilots, receive payments from Medicaid every year. Inevitably a few of the providers will try to defraud the program to line [...]

By | 2019-05-16T12:33:00+00:00 February 4th, 2019|Medicaid Fraud|

What is Whistleblowing?

The eighteenth-century philosopher, Edmund Burke, long ago cautioned that, “All that is necessary for the triumph of evil is that good people do nothing.” That admonition still holds true today.  Whistleblowing involves individuals willing to come forward to stop fraud and other wrongdoing against the government (and by extension, the taxpayers). Those individuals who [...]

By | 2019-05-15T10:38:55+00:00 January 31st, 2019|False Claims Act Information|

What is a Kickback Scheme?

Quite simply, a kickback is an inducement – offering or giving something of value in exchange for getting business referrals. Although that type of behavior can be perfectly legal in some segments of the commercial world, it is not permitted when the business that is being referred is paid for by government healthcare programs. [...]

By | 2019-05-10T11:58:49+00:00 January 25th, 2019|Healthcare Fraud|

Vermont False Claims Act

In 2015, Vermont enacted its own version of the federal False Claims Act.[1] Generally speaking, the Vermont False Claims Act is very similar to the Federal False Claims Act except that the Vermont law prohibits fraud upon the state government, while the federal law prohibits fraud upon the federal government. What the Vermont False [...]

By | 2019-03-27T12:55:31+00:00 January 8th, 2019|False Claims Act Information|

What are Medically Unnecessary Services?

Medical necessity has implications for good, safe patient care and for reimbursement or payment decisions. Although an unnecessary treatment is not always dangerous, it could be used in place of a more appropriate treatment. It could also have side effects or risks that are not justified when the treatment is not necessary in the [...]

By | 2019-05-13T10:57:11+00:00 December 17th, 2018|Healthcare Fraud|

What is the Florida Private Sector Whistleblower Act?

Like many states, Florida generally has an “at-will” employment policy, meaning that employees can be fired at any time for any reason that doesn’t violate a statutory or constitutional protection. For whistleblowers, that statutory protection comes from the Florida Whistleblower’s Act, which protects public employees, or the Florida Private Sector Whistleblower Act, Fla. Stat. [...]

By | 2019-03-27T12:57:02+00:00 October 17th, 2018|False Claims Act Information|

Tennessee Medicaid False Claims Act

(Tenn. Code Ann. §§ 71-5-181 to 185)   The Tennessee Medicaid False Claims Act (“Tennessee Medicaid FCA”) allows whistleblowers to sue in the name of the State of Tennessee where a wrongdoer engages in conduct that defrauds the state or local government of its healthcare dollars. This statute is designed to address Medicaid fraud. The Tennessee Medicaid FCA imposes liability [...]

By | 2019-03-27T12:57:07+00:00 October 10th, 2018|False Claims Act Information|

The Pros and Cons of Whistleblowing

If you observe actions that you believe are illegal and cheating the government, what should you do? What are the pros or cons of deciding to report that misconduct to someone – possibly someone within your company, who could fix things? Or reporting to a regulatory agency that your business interacts with, such as [...]

By | 2019-05-13T10:51:03+00:00 September 26th, 2018|False Claims Act Information|
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