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Charleston Personal Injury Lawyers / South Carolina Healthcare Fraud Lawyer

South Carolina Healthcare Fraud Lawyer

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. Our South Carolina healthcare fraud lawyers can explain your legal options and tenaciously fight for the maximum compensation possible.

What Is Healthcare Fraud?

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.[1] 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.

What Are the Penalties for Healthcare Fraud & False Medical Claims?

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:

  • Incarceration. Making a false Medicaid or Medicare claim can result in a 5-year prison sentence per offense, while a healthcare fraud conviction can result in 10-years in jail per offense.  If a victim is seriously injured or dies due to fraudulent medical treatment, potential incarceration increases from 20 years to a life sentence.
  • Steep Fines. Individuals who make false claims face a fine of $250,000 per offense, while organizations may be required to pay up to $500,000 per offense. Consequently, organizations that engage in prolonged schemes involving multiple violations can face millions (or even billions) of dollars in penalties.
  • Restitution. In addition to a fine, a healthcare provider or organization may be ordered to pay back the amount of improperly obtained funds.
  • Probation. Those convicted of healthcare fraud often face restrictive probation of at least 12 months up to several years.
  • Medical License Suspension. Medical providers found guilty of healthcare fraud may lose their license, permanently compromising their ability to practice medicine.

What Types of Healthcare Fraud Cases Does Mickelsen Dalton Handle?

At Mickelsen Dalton, we are available to represent whistleblowers in fraud cases involving (but not limited to) the following:

  • Billing for services that were never performed
  • Billing for procedures that were not medically necessary
  • Securing patients through bribes and kickbacks
  • Accepting kickbacks for patient referrals (including those prohibited under the federal Stark law)
  • Billing for a covered service when a non-covered service was provided
  • Ordering excessive or inappropriate tests
  • Upcoding (improperly applying codes to receive higher reimbursement rates)
  • Misrepresenting when services were provided or the extent of the services provided
  • Misrepresenting the personnel that provided services
  • Billing for prescriptions that were not filled
  • Reporting diagnoses and procedures incorrectly
  • Prescribing unnecessary drugs or treatment
  • Unlawfully buying back prescription drugs
  • Waiving deductibles (without a justifiable reason)
  • Overstating an insurer’s cost in paying claims
  • Misleading enrollees about health benefits
  • Denying valid claims
  • Undervaluing the amount owed by an insurer to a healthcare provider

These are only a few examples of the types of fraud that occur.

How Much Money Can I Receive by Reporting Medicare of Medicaid Fraud?

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).[2] Successful whistleblowers can be rewarded 15% – 30% of what the government recovers, potentially amounting to millions of dollars.[3]

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.

Call Our Office to Speak with An Experienced Medical Fraud Attorney

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!

[1] 18 U.S.C. § 1347.

[2] The False Claims Act, Department of Justice, https://www.justice.gov/civil/false-claims-act.

[3] 31 U.S.C. §§ 3729-3733.