When wrongdoers defraud the government, whistleblowers acting under the False Claims Act provide powerful protection to U.S. taxpayers.

The Nashville whistleblower attorneys at Cummings Manookian represent False Claims Act whistleblowers in cases involving Medicare and healthcare fraud.  Our resources, skill, and decades of combined experience in healthcare litigation allow us to investigate and prosecute even the most complex FCA matters all the way through trial.

What Is The False Claims Act?

The False Claims Act is a federal law that allows private citizens to sue individuals and businesses that commit fraud against the government. Originally enacted by President Abraham Lincoln, the law creates incentives for ordinary Americans with evidence of fraud to prosecute the responsible parties on behalf of the United States government in exchange for a share of the recovery.

What Conduct Is Covered By The False Claims Act?

The False Claims act covers fraud involving any federally funded contract or program.  It applies to any person or business who submits a bill for payment to the government through those programs.  While the universe of potential violations of the False Claims Act is limited only by the fraudster’s ingenuity and dishonesty, common examples include:

  • Unnecessary Procedure Billing – Billing the government for procedures that were not medically indicated.
  • Double Billing – Charging for the same good or service more than once.
  • Phantom Billing – Billing for goods or services that were never delivered or rendered.
  • Upcoding – Submitting bills for medical procedures at phony higher diagnoses codes in order to receive reimbursement at a higher rate.
  • Employee Upcoding – Charging a physician rate for work that was actually performed by a resident or nurse.
  • Unapproved Billing – Billing for non-FDA approved drugs or devices.
  • Unbundling – Submitting multiple billing codes instead of one in order to increase remuneration.
  • Bundling – Billing more for a panel of tests when a single test was indicated.
  • Billing for Brand – Billing for brand name drugs when generic drugs are provided.

 Who Can Act As A Whistleblower?

With very limited exceptions, any person with evidence of fraud against the government can act as a whistleblower.  In False Claims Act cases, these individuals are known as “relators.”

How Are Whistleblowers Compensated?

In successful False Claims Act cases, the whistleblower is typically entitled to between 15 and 30 percent of the overall recovery.  It is not unusual for the total recovery in a case to reach into the hundreds of millions and occasionally billions of dollars.  For example, Nashville-based hospital giant HCA has paid over half a billion dollars in False Claims Act cases twice.  Because of the size and scope of many healthcare fraud schemes, shares paid to whistleblowers can be enormous.

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Paid to Relators in 2013
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Paid to Relators in 2014

 How Do I Initiate A Claim?

If you are aware of fraud against the government and are considering acting as a whistleblower, your first step is to meet with an experienced False Claims Act attorney.  He or she will evaluate your evidence, first determining whether the defendant’s conduct violates the False Claims Act and, if so, the best strategy for pursuing an award.

Why Choose Cummings Manookian?

The decision to expose healthcare fraud can be difficult and is fraught with peril; particularly when you’ve uncovered the wrongdoing on the job.  You’re risking your position, your professional relationships, and your livelihood.  You’re all too aware that the case may take years, and your employer may attempt to retaliate.  You need dedicated, aggressive attorneys who know the healthcare arena and understand the nuances of your claim.

Brian Cummings and Brian Manookian have decades of experience in healthcare law.  We know the hallmarks of an unnecessary procedure; we can spot false billing – from upcoding to unbundling; and, most importantly, we admire your courage and recognize the risks you’re taking simply to do right.  If you’re aware of fraudulent billing by a healthcare provider, contact us today for a free, no obligation consultation. We appreciate you, and we want to help.