Meyer, Leonard & Allison, PLLC
Where Experience Makes the Difference
|Office (405) 702-9900
Fax (405) 605-8381
116 E. Sheridan, Suite 207
Oklahoma City, OK 73104
Most medical providers (doctors, hospitals, etc.) are individuals that bill Medicare and Medicaid for only the goods and services they provide. There are, however, some that abuse the system by overbilling, up-coding, and defrauding the Medicare system. When this happens, it's all of our collective tax dollars being stolen.
The amount of potential recoveries and rewards is huge and widespread.
The federal and Oklahoma State governments are extremely serious in their desire to catch those abusing the system, but those working for the government don't have the resources to do it all themselves. They rely on you, and the legal system is set up to handle these matters.
There are different types of Medicare and Medicaid Fraud, all sharing one common theme: the provider does something that results in more payment from Medicare to the provider than should be paid. There are specific laws that apply to Medicare and Medicaid fraud, some of which require the offending provider to pay a civil fine, and others that are criminal in nature and may include time in jail. Some of the more common types of fraud found in the healthcare industry are as follows:
The government wants, and needs, your help in combating Medicare and Medicaid Fraud, and they have provided a sizable financial incentive and legal protections for you to come forward.
The specific law is sometimes called "Qui Tam" (pronounced "Key-Tam"). The phrase "qui tam" is really a shortened version of the Latin phrase "qui tam pro domino rege quam pro se ipso in hac parte sequitur," which means "he who sues in this matter for the king as well as for himself."
What it means in practical terms is that the government will pay you if you are an individual who knows of and brings and action for government fraud. As a tax-paying individual, you are being cheated by every action of fraud on the government, so a qui tam lawsuit is one where you go after the government defrauder on behalf of yourself and the government.
The amount of money a whistleblower can receive from a successful claim can be substantial, ranging from approximately 10-30% of the amount the government recovers. Depending on what claims and charges are found against the defrauder, penalties can include not only the amount of money actually defrauded, but also penalties ranging from $5,000 to $25,000 per claim sent to the government. Additionally, in some instances, the amount of the penalty is tripled. It is, therefore, not uncommon for penalties to be assessed in amounts in the millions, tens of millions, and even hundreds of millions of dollars.
Qui tam claims can result from many situations, but some of the more typical include:
For more information, the U.S. Office of Inspector General ("OIG") has produced an easy to understand overview of healthcare fraud for physicians, which outlines a number of example cases and scenarios.
Oklahoma has a Medicaid Fraud Control Unit within the state Attorney General's office. The director for the Fraud Control Unit works within the AG's office at MFCU Medicaid Fraud Control Unit of Oklahoma Office of the Attorney General 313 N.E. 21st Street Oklahoma City, OK 73105, Tel: 405-521-3921 Fax: 405-522-4875.
Oklahoma has three districts of the U.S. Department of Justice, Western (Oklahoma City), Northern (Tulsa), and Eastern (Muskogee). As reported by the U.S. DOJ and the Daily Oklahoman (Dec.19, 2010), the following were Oklahoma results:
* The Eastern District collected $2.1 million.
* The Northern District collected $17 million and obtained forfeiture orders of $52 million in criminal and civil cases. So far, $1.1 million has been paid to victims.
* The Western District reported $5.2 million collected.
A listing of all states' Medicaid Fraud Control Units is maintained at the OIG.
The laws governing fraud against the government are some of the most complex and dense in our legal system and are dealt with within the Federal Judiciary. Understanding whether you have a claim, what to do about it, and how to get protection from retaliation are matters which should be considered confidentially with an attorney who understands the complex body of law.
Meyer, Leonard & Allison in Oklahoma City has extensive experience in the federal arena and competence in assessing qui tam matters. To consult in confidence with one of our attorneys, please call 405-702-9900.