Legal Insights & Articles

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|

New Hampshire False Claims Act

The New Hampshire False Claims Act (“New Hampshire FCA”) was first enacted in 2004. It authorizes whistleblowers with knowledge of fraudulent efforts by persons or businesses to obtain New Hampshire state funds or to avoid an obligation to pay New Hampshire state funds to file suit on behalf of the state of New Hampshire. See N.H. [...]

By | 2019-03-27T12:57:15+00:00 September 24th, 2018|False Claims Act Information|

Common Types of Pharmaceutical Fraud

Pharmacy fraud can take many forms, some of which can be very costly to taxpayers when the pharmaceuticals involved are paid for by government-funded health programs like Medicare or Medicaid. Some of the most common types of pharmacy fraud include: auto-refilling fraud, off-label marketing of drugs, average manufacturer price/best price fraud, drug switching, pharmaceutical [...]

By | 2019-05-13T10:59:20+00:00 September 20th, 2018|Healthcare Fraud|
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