The Whistleblower Firm of Nolan Auerbach & White is a Medicare Fraud Law Firm with lawyers helping whistleblower clients in cases ranging from coding false claims, long term care fraud, DRG false claims, PPS false claims, to outpatient APC false claims, Stark law, and Medicare kickback violations.
With over 25 years of experience and $6 billion collected and returned to taxpayers since the False Claims Act was amended in 1986, courageous Medicare Whistleblowers call on our Fraud Attorneys with confidence.
Contact the Medicare Whistleblower Attorneys at Nolan, Auerbach & White to get started on a free and confidential review of your important case today. Call our Whistleblower Healthcare Fraud Attorneys at 800-372-8304 today.
Private citizens play a critical role in reporting healthcare fraud. Under the qui tam provisions of the False Claims Act, private citizens may be entitled to receive a percentage of the qui tam recovery. If you are aware of fraud within the healthcare industry, the law protects you as a whistleblower. We invite you to begin by scheduling a free review of your case today. Contact us online or call us at 800-372-8304 to get started. Your interaction with our qui tam attorneys is confidential.
If you are aware of Medicare fraud, the law protects you as a whistleblower. We encourage you to begin this important duty and service by scheduling a free review of your case today with the Medicare Fraud Attorneys at the Whistleblower Firm. Contact us online or call us at 800-372-8304 to get started. Our qui tam lawyers, with more than 25 years of experience, will keep all interactions confidential.
Learn More: Whistleblower Protection
Fraudulent activity with Medicare typically happens when there is a violation of the False Claims Act. Fraud can be categorized by provider type and fraud scheme. Violations are made by providers such as hospitals, skilled nursing facilities, home health agencies, pharmacies, HMO’s and physician groups. The Medicare fraud lawyers at Nolan, Auerbach, and White have broad familiarity with these areas.
Potential False Claims Act violations include the following:
If you have become aware of any of these types of activities, our firm of Medicare Fraud Lawyers can help when you’re ready to learn more about the qui tam process and Report Medicare Fraud.
Our Medicare Fraud Law Firm is familiar with the many vulnerabilities hospitals have to fraudulent behavior. We are fully qualified to represent you to report unethical medical billing practices and other instances of healthcare fraud.
Some of the most important steps our Medicare Fraud Attorneys recommend for how to report healthcare fraud include:
LEARN MORE:
The Medicare program consists of four parts, and accordingly, fraud corresponds to these four categories. The Medicare Fraud Attorneys at the Whistleblower Firm are available to discuss each of these with you during a free case consultation.
Medicare Part A authorizes the payment of federal funds for hospitalization and post-hospitalization care. This typically includes payments to hospitals, skilled nursing facilities, home health agencies, and similar under the Prospective Payment System (PPS).
Insurance companies that process Medicare Part A claims are referred to as Medicare Administrative Contractors. 42 U.S.C. § 1395h.
Part A violations may include:
Contact our Medicare Fraud Attorneys today to report Part A violations.
Medicare Part B authorizes the payment of federal funds for medical and other health services, including, without limitation, physician services, supplies, and services incident to physician services, laboratory services, outpatient therapy, diagnostic services, and radiology services.
Insurance companies that contract with the Centers for Medicare & Medicaid Service (CMS) to process Medicare Part B claims are known as Medicare Administrative Contractors (MACs). They process and pay billions of dollars of Medicare benefit claims on behalf of the federal government.
When services are covered under Part B, Medicare then uses one of the two following payment methods: (1) payment to the patient; (2) “assignment” method – payment to the hospital, doctor (or other healthcare entity or supplier).
Part B violations may include:
Contact our Medicare Fraud Lawyers today to report Part B violations.
Part C of the Medicare Program, known as Medicare Advantage, allows Medicare beneficiaries to obtain their medical benefits through private managed health care organizations (“MA Organizations”). Under this program, MA Organizations enter into contracts with CMS, according to which CMS pays each MA Organization a set amount for each Medicare beneficiary it enrolls, depending upon the beneficiary’s risk adjusted score. In exchange, MA Organizations agree to provide their Medicare enrollees with, at a minimum, all the benefits the beneficiary would be entitled to receive under the original Medicare program. Medicare’s payments to the managed care plan replace the amounts Medicare otherwise would have paid under traditional Medicare.
Part C violations may include:
Contact our Medicare Fraud Lawyers today to report Part C violations.
In the Medicare Part D plan, all Medicare beneficiaries get access to the Medicare drug benefit via private plans approved by CMS. The drug benefit is offered through Medicare Advantage prescription drug (MA-PD) plans and stand-alone Prescription Drug Plans (PDPs). Part D is a market model that transfers risk to private plan sponsors, which then play the role of insurers for Part D benefits.
Medicare pays claims based upon a bare electronic submission indicating that certain supplies or services for a particular patient covered by Medicare have been rendered or furnished. Beyond computer edits, only minimal verification or due diligence exists before payment is made.
Part D violations include:
Contact the Whistleblower Firm’s Medicare Fraud Lawyers today to report Part D violations.
LEARN MORE:
For decades, Healthcare Fraud cases have brought the most significant return to the U.S. Treasury. Many of these cases, and the resulting returns to the public fisc, were made possible by brave whistleblowers stepping forward to expose clear cases of fraud. Using the qui tam provisions under the False Claims Act, these individuals were able to stop fraud and have cumulatively been awarded hundreds of millions of dollars for their part in stopping this fraud. Medicare Fraud Attorneys play a significant role in guiding clients through these complex legal battles.
Two Federal laws which proscribe illegal conduct, in addition to the FCA, are the STARK LAW and ANTI-KICKBACK LAW.
The Stark law, 42 U.S.C. §1395nn, is also known as the Physician Self-Referral Law. If a physician (or immediate family member) has a direct or indirect financial relationship (ownership or compensation) with an entity that provides any of certain designated health services (“DHS”), the physician cannot refer patients to the entity for DHS, and the entity cannot submit a claim to Medicare for such DHS unless the financial relationship fits in a statutory or regulatory exception.
The Stark law was intended to prohibit physicians from profiting (actually or potentially) from their own referrals. The Stark law acts to sanction improper physician referrals by providing penalties for illegal referrals prospectively. Its effect is to prohibit relationships that have been demonstrated to encourage over-utilization. It is a strict liability statute, i.e., there is no need to show knowledge or intent.
The Medicare program depends on physicians and other health care professionals exercising independent judgment in the best interests of patients. Hospital admissions that lack medical necessity, for instance, are not in the best interest of the patients, as patient harm can result.
Financial incentives tied to referrals tend to corrupt the health care delivery system in ways that harm the federal programs and their beneficiaries. Corruption of medical decision-making can result when a physician refers a patient to a provider based on the physician’s financial self-interest instead of the patient’s best interests.
Each of these may represent financial windfalls to physicians resulting in hospital referrals in violation of the “Stark law.”
Get a Medicare Fraud Attorney on your side. Start your free case review today.
The other law is the federal Anti-kickback Statute, 42 U.S.C. § 1320a-7b(b). It arose from congressional concern that payoffs to those who can influence healthcare decisions will result in goods and services being provided that are medically unnecessary, of poor quality, or even harmful to a vulnerable patient population. To protect the program’s integrity from these difficult-to-detect harms, Congress enacted a per se prohibition against the payment of Medicare kickbacks in any form, regardless of whether the particular kickback gave rise to overutilization or poor quality of care.
The Anti-kickback statute prohibits any person or entity from making or accepting payment to induce or reward any person for referring, recommending, or arranging for federally-funded medical services, including services provided under the Medicare, Medicaid, and TRICARE programs.
Our team of Medicare fraud lawyers has helped our clients in cases that have included coding false claims, long-term care fraud, DRG false claims, PPS false claims, outpatient APC false claims, Stark law and Medicare kickback violations, and other types of Medicare fraud.
Medicare has been amended and expanded many times since it was enacted in 1965, and although efforts have been made to curtail Medicare fraud, we still have a long way to go. Medicare fraud has cost taxpayers billions over the last decade, but with the help of whistleblowers, a significant portion has been returned to the U.S. Treasury.
The elimination of third-party payments (“assignment of benefits”) directly to other providers, instead of reimbursement of the beneficiary will help. However, cracks in the system still exist. Healthcare fraud is simply ripe for disclosure by Medicare whistleblowers. The qui tam provisions of the False Claims Act are available as an incentive for Medicare fraud whistleblowers to come forward and expose fraud.
It’s time to report the Medicare you’ve become aware of. Join the many whistleblower heroes that have exposed violations of the law by taking a stand for justice. Contact our team of Medicare Fraud Lawyers today. It could result in you sharing a percentage of the funds recovered from fraudulent activity.
Our law firm representing whistleblowers has the experience to discuss in-depth areas of Healthcare Fraud. Here are additional abuses our Medicare fraud lawyers encourage whistleblowers to report:
Get started by filling out our online form for potential clients, or give Nolan, Auerbach, and White and our experienced team of Qui Tam Medicare fraud attorneys a call today at 800-372-8304.
When a whistleblower reports Medicare Fraud through a qui tam case, rewards are available. Our whistleblower law firm can guide you through the qui tam process and represent you in your case. We will evaluate your potential case to determine liability and damages.
The Centers for Medicare and Medicaid Services estimates that improper payments in 2020 were approximately $25.74 billion, about 6.27 percent of payments.
Medicare abuse occurs when practices contribute either directly or indirectly to unjustified costs to the Medicare Program. This covers a wide range of practices including lack of medical necessity. If you are aware of Medicare fraud and abuse, contact our Healthcare Fraud Law Firm.
Kathleen Hawkins, RN MSN, had been employed by Defendant, Catholic Healthcare West (CHW) for approximately 6 years when she decided she had had enough of trying to change the hospital system from within.
CHW, a California not-for-profit corporation that operated hospitals in California, Arizona, and Nevada, was at the time the eighth largest hospital system in the nation and the largest not-for-profit hospital provider in California.
Joe Strom contacted us in 2005. We were very grateful that he did. We immediately formed an all-star legal team and a process to stop a very harmful pharmaceutical marketing strategy. It was this process we set into motion that ultimately returned hundreds of millions of dollars to the U.S. Treasury, and a portion of that, very well-deserved, into Joe’s bank account.
Joe told us a very troubling story about the off-label promotion of a pharmaceutical drug for patients who already suffered from chronic heart failure.
Bruce Moilan was a seasoned hospital systems expert by the time he contacted our Firm. At the time he decided to file his qui tam lawsuit, he was employed by South Texas Health System as a System Director for Materials Management. In this position, he oversaw $24 million in annual purchases of supplies and equipment and helped determine budget, reduction and cost analysis throughout the contract bidding and negotiations process. His job was to insure proper implementation for purchasing, receiving and management of inventory, for McAllen Hospitals, L.P.
