False Claim Act (FCA) laws exist to prevent fraud and save taxpayers money. Numerous state and federal laws aim to prevent abuse within the United States medical system. Sadly, some folks continue to break the law for financial gain. Fortunately, honest people come forward and expose criminal activity within the healthcare field. These brave individuals are known as whistleblowers. So, if you suspect healthcare fraud in Florida, or another State, contact an experienced healthcare fraud attorney to ensure
Healthcare Fraud Examples
Numerous types of healthcare fraud and abuse may occur at any medical facility or supply center. Some examples include:
- Receiving kickbacks, bribes, or cash for referrals, medical services, or supplies
- Billing for services never received
- Providing fake information to Medicare or Medicaid
- Performing unnecessary procedures
- Overprescribing drugs
- Overcharging for a procedure, medication, or equipment
- Changing medical coding to receive more money
Florida False Claims Act Laws
Laws exist at the federal and state level regarding fraudulent medical claims.
- Federal Law- the U.S. False Claims Act (31 U.S.C. 3729-3733) targets fraud against federally funded healthcare programs. The federal FCA allows private citizens with knowledge of a false claim to bring a civil suit on behalf of the U.S. Government. The person bringing the claim is known as a “whistleblower” under this “qui tam” provision. Sometimes the Government joins the suit. If that happens, the whistleblower’s reward may be lower; but, it will still be significant. This occurs in very large cases. Your experienced attorney will guide you through this type of complicated case.
- Florida State Law- Florida Statutes, Section 68.081 allow the state to pursue individuals or groups committing healthcare fraud. Florida’s False Claims Act is similar to the federal statute. Like the federal statute, violators receive fines per false claim. Once again, your attorney will discuss the financial implications of your case.
Define “Qui Tam”
The Latin term “qui tam” comes from the phrase “qui tam pro domino rage quam pro se ipso in hac parte sequitur” which translates to “he who sues on behalf of the king as well as himself.” Simply put, qui tam provisions allow an everyday citizen to file a lawsuit on behalf of the U.S. government or the state of Florida. Of course, anyone filing a lawsuit must have firm knowledge of healthcare fraud. Fortunately, there are laws and provisions to protect whistleblowers. As always, discuss matters only with your attorney.
Recent Florida Healthcare False Claims Act Cases
FCA cases generally involve large amounts of money. Any monies obtained fraudulently must be returned to the government. When a whistleblower (relator) files this type of case, the relator receives a percentage of the funds recovered. Some examples include:
- United States and the State of Florida ex rel. Graham and Frauenhofer v. Florida Cardiology, P.A. – This case involved two cardiologists and eight other physicians. The whistleblowers sued under the qui tam provisions of the False Claims Act. The 10 doctors were found guilty of numerous fraudulent billing charges. A couple examples include: first, Florida Cardiology billed for more stents than were inserted into patients. Second, all 10 physicians billed for services and procedures that may have never happened. In fact, they were out of the country when procedures were scheduled. The settlement was $2 million and whistleblowers received $420,000.
- United States ex rel. Castillo v. Vista Clinical Diagnostics, LLC – This medical fraud case involved three labs which inserted diagnostic claim codes NOT provided by physicians. In other words, they were adding charges to Medicare and Medicaid patients’ bills. Three Clermont Labs in Florida, Virginia, and North Carolina were involved in this fraudulent scheme. A former employee sued under the whistleblower False Claims Act. He received $440,000 of the $2.45 million settlement. Once again, a brave person exposed medical fraud.
Florida Healthcare Fraud by Area
Healthcare fraud can potentially occur in any city or region, but certain areas might be more susceptible due to population size, the concentration of healthcare facilities, and other socio-economic factors. In Florida, the main cities where healthcare fraud might be more prevalent include:
Miami: Miami is known for its large healthcare sector and has been a hotspot for healthcare fraud in the past. The city has a high concentration of Medicare and Medicaid recipients, making it a target for fraudulent activities.
Tampa: With a significant population and numerous healthcare providers, Tampa is another area where healthcare fraud can occur.
Orlando: As a major city with a large population and a thriving healthcare industry, Orlando is also at risk for healthcare fraud.
Jacksonville: Jacksonville is the largest city in Florida by area and has a substantial healthcare network, which can be susceptible to fraud.
Fort Lauderdale: Close to Miami, Fort Lauderdale also has a significant healthcare presence and has seen cases of healthcare fraud.
West Palm Beach: This area has a high percentage of elderly residents, making it another target for fraudulent healthcare schemes.
Naples: Known for its affluent population, Naples has seen instances of healthcare fraud, particularly targeting its older residents.
These cities have larger healthcare systems and more extensive use of Medicare and Medicaid services, which can increase the risk of healthcare fraud.
What Should I Do If I Suspect Healthcare Fraud in Florida?
If you suspect healthcare fraud in Florida, it’s crucial to remain discreet. Your first step should be to contact an experienced Florida healthcare whistleblower lawyer. An attorney will guide you through the legal process, ensuring your actions are both effective and protected. If your attorney determines that you have a viable case, they will help you gather the necessary evidence.
During this time, it’s important to keep the matter confidential and avoid discussing it with anyone. This confidentiality period allows you to make necessary arrangements, such as finding new employment if needed. Ultimately, hiring a skilled healthcare law attorney is key to achieving a successful outcome.
(Note: While this guidance is tailored for Florida, the principles apply nationwide, making it relevant for others facing similar situations across the country.)