If you’ve become aware of Medicaid Fraud, the Whistleblower Firm of Nolan, Auerbach & White can help. Our Medicaid Fraud Attorneys represent and advocate for whistleblowers in lawsuits filed in Federal Court. We work with the Department of Justice while your case is under seal, as they confidentially investigate your claims.
With over 25 years of experience and $6 billion collected and returned to taxpayers since the False Claims Act was amended in 1986, courageous Medicaid Whistleblowers call on our False Claims Act Lawyers with confidence.
Contact the Medicaid Whistleblower Attorneys at Nolan, Auerbach & White to get started on a free and 100% confidential review of your important case. Call our Whistleblower Healthcare Fraud Attorneys at 800.372.8304 today.
The purpose of the Qui Tam provisions of the FCA is to encourage private individuals aware of Medicaid Fraud and Abuse to bring such information forward under a confidential and protected status. Our experienced team of Medicaid Fraud Lawyers at The Whistleblower Firm can advise you of your options and expectations. Begin this important duty and service by scheduling a free review of your case.
For many Medicaid Fraud Whistleblowers, it is possible to collect a percentage of what has been recovered as an award for this vital service. CMS Whistleblower rewards for Medicaid vary from 15-30 percent of the amount collected.
LEARN MORE: Whistleblower Protection
Fraudulent activity with Medicaid typically coincides with a violation of the False Claims Act. When you’re ready to explore your options as a potential whistleblower, our Medicaid Fraud Lawyers are here to confidentially discuss the details of your important case.
Because spending for the Medicaid program is projected to exceed $900 billion by fiscal year 2025, reducing Medicaid Fraud will save consequential taxpayer dollars. One of the biggest issues facing the Medicaid program is a lack of timely, accurate, and complete data on the front end, before payment to healthcare providers. The work and oversight function of the Centers for Medicare and Medicaid Services (CMS) and its contractors are hampered in a “pay and chase” system when reimbursements are made to healthcare providers without any opportunity (other than edits) to ensure medical necessity, services actually delivered, appropriate coding, etc.
Our Medicaid Fraud Attorneys at The Whistleblower Firm are ready to confidentially discuss your case, along with potential CMS whistleblower rewards (via federal and state qui tam lawsuits ) involved in Medicaid Fraud Lawsuits. Find out your options by calling us or filling out our online form.
LEARN MORE: Medicaid Fraud Oversight Issues
The Medicaid Rebate Program is one example of Medicaid Fraud. The scenario begins as a beneficiary obtains a prescription drug from a participating pharmacy, which has purchased the drug in the marketplace from a manufacturer or wholesaler. The pharmacist submits a claim and then receives payment from the state Medicaid agency based on the state’s formula for typically (Average Wholesale Price) AWP less a percentage.
The manufacturer then pays a rebate, each quarter, for all of its drugs reimbursed by Medicaid each quarter. In order to decrease the amounts owed to the states, some pharmaceutical companies misrepresent material facts in their quarterly submissions to the Medicaid Rebate Program reporting, to include misrepresentation of the regulatory origin/status of their Brand Name Drugs, the Average Manufacturer Price (AMP), and/or the Best Price.
The rebate for drugs is based in part on two prices submitted by the manufacturer to CMS each calendar quarter:
The AMP and the Best Price must be reported for each respective dosage form and strength of all prescription drugs purchased on behalf of Medicaid beneficiaries. Those prices, which remain confidential, serve as reference points in determining drugmakers’ rebate obligations.
CMS calculates the unit rebate amount (URA) for each covered drug using price data submitted by the drug manufacturers. Each quarter, each State Agency sends an invoice to each drug manufacturer/labeler, using the URA from CMS and the units dispensed for each drug (from its own records), to determine the actual rebate amounts due from the manufacturer. The manufacturer has 38 days from the day a State Agency sends an invoice to pay the rebate and avoid interest charges.
In order to determine rebate amounts, the reporting requirements include designation of a drug’s status into one of three categories:
A Single Source, and an Innovator Multiple Source Drug, are both commonly known and referred to herein as a “Brand Name Drug,” while a Non-Innovator Multiple Source Drug is commonly known as, and referred to herein as a “Generic Drug.”
For Brand Name drugs, the rebate consists of two components:
The manufacturers of Brand Name Drugs almost always owe the additional rebate. In 2003, for instance, the drugs for which an additional rebate was owed represented about 84 percent of Medicaid’s reimbursements for brand-name prescription drugs. In its report, “The Rebate Medicaid receives as Brand-Name Prescription Drugs” dated June 21, 2005, the Congressional Budget Office of the United States, estimated that in 2003, the average rebate received by Medicaid for brand-name prescription drugs was 31.4% of the AMP.
The rebate for Generic Drugs is much less than for Brand Name Drugs. It is a base rate of 11% of AMP, with no additional rebate. In contrast, the total rebates due for Brand Name Drugs have typically been within a couple of points of 31% of AMP, a difference of roughly twenty (20) percent.
Our Medicaid Fraud Lawyers can help clarify whether or not fraud exists in each scenario. Contact us for a free and 100% confidential case review.
Our law firm representing whistleblowers has the experience to discuss in-depth areas of Healthcare Fraud. Our Medicaid Fraud Attorneys are advocates for many CMS whistleblowing clients and those exposing other fraud that may include:
Explore your options as a CMS whistleblower by filling out our confidential online form for potential clients or give Nolan, Auerbach, and White and our experienced team of Qui Tam Medicaid Fraud Attorneys a call today at 800.372.8304.
CONTACT THE WHISTLEBLOWER FIRM
Does your case have merit? We invite you to confidentially submit your facts to our experienced Medicaid Fraud Lawyers for a free case evaluation.
Join the many whistleblower heroes we have represented. We’re here to help you take the next courageous step forward by doing the right thing and pursuing justice. We understand the pressure of becoming aware of significant fraud, and we are here to alleviate that pressure and turn a negative situation at work into a positive outcome for you.
You are protected by law against retaliation and whistleblowers can receive a percentage of the funds recovered from the Defendant under the FCA.
Get started by filling out our online form, or call our team of experienced Medicaid Fraud Lawyers at 800.372.8304.
Eligible whistleblowers may receive between 15-30 percent of the amount collected in Medicaid Fraud cases, through the qui tam provisions of federal and state statutes. To learn more about the potential of your knowledge, obtain quick feedback, and learn what we can do for you, begin a free evaluation of your important case.
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.
