Legal Insights & Articles

What is Best Price Fraud?

“Best Price” is a term used in connection with Medicaid reimbursement for brand name prescription drugs. Essentially, a drug manufacturer is required to charge Medicaid no more than whatever its best (lowest) price is to a non-government (or commercial) payor. Because Medicaid does not buy drugs outright and furnish them to patients, the government [...]

By |2020-08-24T11:49:04-04:00March 11th, 2019|Healthcare Fraud|

What is Customs Fraud?

Customs fraud is a catch-all term for frauds committed by companies trying to evade payments that are owed to the federal government in connection with the importation of goods into the United States. While there are many variations, the two major types of payments that are in play for imported goods are “antidumping” duties [...]

By |2020-08-24T11:49:33-04:00March 6th, 2019|Customs Fraud|

Whistleblower Rewards: How They Work

The federal False Claims Act (“FCA”) allows an individual with knowledge of fraud upon the federal government, often known as a whistleblower or qui tam relator, to bring a lawsuit on the federal government’s behalf to recover the funds. Many states  have adopted similar laws that apply to fraud upon state and local government entities. [...]

By |2020-08-24T12:05:31-04:00February 22nd, 2019|False Claims Act Information|

What is a Qui Tam Relator?

In False Claims Act (“FCA”) cases, the qui tam 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 has been committing [...]

By |2020-08-25T13:18:58-04:00February 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 |2020-08-24T12:06:29-04:00February 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 |2020-08-24T12:07:04-04:00February 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 |2020-08-24T12:07:36-04:00January 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 |2020-08-24T12:08:09-04:00January 25th, 2019|Healthcare Fraud|
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