How Do Lawyers Approach False Claims Healthcare Fraud Cases?

Below, False Claims Act healthcare fraud attorney Tony Munter discusses how healthcare fraud cases can be brought forward using the False Claims Act and how he approaches these types of cases. To learn more about False Claims in Healthcare Fraud cases schedule a free consultation today.

Is Medicare/Medicaid Fraud One of the Only Ways a Healthcare Fraud Case Can be Brought Under the FCA?

TRICARE, any government program that pays for health insurance for government employees, for example, all of those would be covered under the False Claims Act because all of those use government money to pay for healthcare, so certainly it is possible.

As a practice though, most healthcare cases are going to involve all kinds of government funding because it’s a systematic attempt to bill too much, to bill for services that weren’t provided, or to market something illegally. Because of that, it will tend to be a situation in which every kind of patient will have been ripped off. That isn’t always the case, but it is usually the case that when there’s healthcare fraud. It will end up defrauding several government programs.

What’s Your Approach to Healthcare Fraud Cases?

Well, I try to find and talk to whistleblowers who are really concerned with the wrongful practice and work with them to learn why what’s wrong. I think it’s not enough to just be a highly technical matter of violating a regulation. You want to start with an obvious wrongful practice such as charging for stuff that shouldn’t be charged for or doing medical procedures that aren’t required or needed. Then, work your way back to figure out how many different specific regulations are being violated. You want sort of the big picture to be an almost visceral type of fraud to be able to present as a strong case to the government. Usually, with healthcare whistleblowers, that’s what makes them want to come forward. So, you have to spend a great deal of time with them and learn an awful lot about what happened on the job. Most healthcare whistleblowers will remember some important things right away, but they will have been working on the job for quite a while and may know a lot more than they initially remember if you interview them a few times.

So, my approach is to work with the whistleblower as much as I can to learn as much as I can about what it was that got them to my office in the first place.

 Why Should a Whistleblower Contact An Experienced Attorney Before Talking About The Fraud Being Committed?

Well, there’s a lot of reasons. First of all, if you’re still employed, then you want to know your rights before you take any actions. You may or may not have rights that you don’t know about  so you certainly want to know that.

It may be that you have a huge whistleblower case that you should file immediately because it could not only stop wrongful practices, but also be worth a considerable amount of money to the government. Or it may be that the practices you are seeing, while somewhat unethical, don’t rise to the level of fraud under healthcare. You don’t want to act without having some analysis done as to exactly what it is you have as a case because that’s how you can compromise your right.

You certainly want to know about that before you contact the press or any public forum. It’s much harder to file a False Claims Act case, for example, based on information that becomes public. You want to know first of all what your rights are before you act. That’s true for almost every kind of False Claims Act case. Most experienced False Claims Act lawyers would at least talk to you initially without requiring you to pay money upfront so you at least have some idea of what your rights are before you do anything.