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Over 126 million Americans obtain healthcare coverage through Medicare and Medicaid, meaning that government healthcare plans cover nearly one in three individuals. Consequently, over $1.3 trillion flows from these programs each year, motivating individuals and companies to commit rampant and widespread fraud.
Healthcare fraud and abuse cost states and the federal government billions of dollars each year, diverting funds that could help cover legitimate medical care into the hands of criminals. However, from drug and medical device manufacturers, insurers, and hospitals to pharmacies, hospices, laboratories, and physicians, the U.S. Justice Department recovers over $2.5 billion from unscrupulous medical providers each year thanks to brave whistleblowers.
When individuals expose healthcare fraud (such as kickbacks, fraudulent billing, false claims, unnecessary medical procedures, etc.) that helps the government recover funds, they are eligible for a substantial part of the financial award recovered for their efforts. For example, of the over 500 cases brought by whistleblowers in 2019, their share of the legal recovery amounted to over $244 million.
If you have been the victim of or know of a company engaging in healthcare fraud, we urge you to call our office to schedule a complimentary consultation. We can explain your legal options and tenaciously fight for the maximum compensation possible.
Under federal law, using lies or falsehoods when filing a medical claim to gain a benefit or profit is considered healthcare fraud, a federal offense that carries substantial civil and criminal penalties. Still, nearly 10% of healthcare reimbursements are paid out on fraudulent claims. Because Medicaid and Medicare are regular targets of fraudulent claims, specific laws were enacted that make defrauding these programs (and the government) a felony offense.
States and federal authorities regularly work together to investigate claims, meaning that businesses and healthcare personnel can face both state and federal charges for committing fraud against the government. If found guilty, a defendant may be subject to some or all of the following:
At Mickelsen Dalton, we are available to represent whistleblowers in fraud cases involving (but not limited to) the following:
These are only a few examples of the types of fraud that occur.
In addition to allowing the government to pursue perpetrators of fraud, the Federal False Claims Act allows private citizens to file lawsuits on behalf of the government against those who defraud Medicare and Medicaid (referred to as Qui Tam suits). Successful whistleblowers can be rewarded 15% – 30% of what the government recovers, potentially amounting to millions of dollars.
If you know of widespread healthcare fraud, we encourage you to call our office to schedule a complimentary consultation to learn about your options for pursuing a qui tam lawsuit. If you retain Mickelsen Dalton, you will not need to pay us any fee or advance any costs, as our fee and the costs that we advance are paid by the federal government as part of the compensation paid to legal counsel and whistleblowers pursuant to federal statutes. As a result, in a case involving significant government fraud, you may be entitled to significant compensation for your efforts.
Have you discovered illegal claims or activity at your company? Is your employer cheating the U.S. government through double-billing, over-charging, or improper or fraudulent billing, coding, or other activities? The federal government offers certain whistleblowers both legal protection and financial rewards for reporting healthcare and other fraud.
If you are aware of healthcare fraud, we encourage you to call our office to schedule a free case evaluation. We can listen to the facts of your case and explain your legal options. You will never pay a fee unless we are successful in securing compensation on your behalf, and we advance litigation expenses, meaning you will not have to pay any up-front costs for our quality representation.
Contact Mickelsen Dalton LLC today!
 18 U.S.C. § 1347.
 The False Claims Act, Department of Justice, https://www.justice.gov/civil/false-claims-act.
 31 U.S.C. §§ 3729-3733.