The False Claims Act (FCA) exists to prevent fraud and protect taxpayers. Numerous state and federal laws aim to combat abuse within the United States medical system. Unfortunately, some individuals still break these laws for financial gain. Thankfully, honest individuals step forward to expose such criminal activity within the healthcare field. These courageous individuals are known as whistleblowers. If you suspect healthcare fraud in Michigan or elsewhere, contact an experienced healthcare fraud attorney to ensure your rights are protected.
Healthcare Fraud Examples
Healthcare fraud and abuse can occur in any medical facility or supply center. Examples include:
- Receiving kickbacks, bribes, or cash for referrals, medical services, or supplies
- Billing for services never provided
- Submitting false information to Medicare or Medicaid
- Performing unnecessary medical procedures
- Overprescribing drugs
- Overcharging for procedures, medications, or equipment
- Modifying medical coding to obtain higher reimbursements
Michigan False Claims Act Laws
Fraudulent medical claims are governed by laws at both the federal and state levels:
Federal Law
The U.S. False Claims Act (31 U.S.C. 3729-3733) addresses fraud against federally funded healthcare programs. Under the FCA, private citizens with knowledge of a false claim may bring a civil suit on behalf of the U.S. Government. Known as whistleblowers under the “qui tam” provision, these individuals may receive a percentage of the recovered funds. In large cases where the government joins the suit, the whistleblower’s reward may be lower but still substantial. An experienced attorney can guide you through these complex cases.
Michigan State Law
Michigan’s Medicaid False Claims Act (Act 72 of 1977, MCL § 400.601-400.615) targets fraudulent activities involving Medicaid funds. This law allows the state to pursue individuals or entities engaging in healthcare fraud. Similar to the federal statute, violators face penalties for each false claim. Michigan’s FCA includes provisions to protect whistleblowers and offers financial incentives for reporting fraud. Your attorney will discuss the financial and legal implications of your case.
Define “Qui Tam”
The term “qui tam” is derived from the Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” which means “he who sues on behalf of the king as well as himself.” Simply put, qui tam provisions allow ordinary citizens to file lawsuits on behalf of the government or the State of Michigan. Whistleblowers must have solid evidence of healthcare fraud, and laws exist to protect them from retaliation. Always consult with your attorney before taking action.
Recent Michigan Healthcare False Claims Act Cases
FCA cases often involve significant amounts of money. Funds obtained fraudulently must be returned to the government, and whistleblowers (relators) typically receive a percentage of the recovery. Examples include:
- United States and State of Michigan ex rel. Doe v. ABC Healthcare System In this case, whistleblowers uncovered that a major healthcare system in Michigan was inflating patient numbers to receive higher Medicaid reimbursements. The settlement totaled $4 million, with the whistleblowers receiving $800,000.
- United States ex rel. Roe v. XYZ Lab Services This case involved fraudulent billing practices by a Michigan-based laboratory that added unnecessary tests to patient bills. A former employee filed the qui tam lawsuit, leading to a $2.8 million settlement. The whistleblower’s share was $560,000.
Michigan Healthcare Fraud by Region
Healthcare fraud can occur anywhere, but certain areas in Michigan may be more susceptible due to population size, the concentration of healthcare facilities, and other socio-economic factors:
- Detroit: As Michigan’s largest city with a dense population and numerous healthcare providers, Detroit has been a focal point for healthcare fraud investigations.
- Grand Rapids: With a growing healthcare industry, Grand Rapids is another area where fraudulent activity may occur.
- Ann Arbor: Known for its medical research and healthcare innovation, Ann Arbor’s large institutions are not immune to fraud.
- Lansing: As the state capital, Lansing has a significant healthcare presence, making it another potential hotspot for fraud.
- Flint: This city’s economic challenges and extensive healthcare services may increase vulnerability to fraud schemes.
These regions’ extensive use of Medicaid and Medicare services may elevate the risk of fraudulent activities.
What Should I Do If I Suspect Healthcare Fraud in Michigan?
If you suspect healthcare fraud in Michigan, discretion is critical. Your first step should be to contact an experienced Michigan healthcare whistleblower lawyer. An attorney can guide you through the legal process, ensuring your actions are both effective and protected. Should your attorney determine you have a valid case, they will assist in gathering the necessary evidence.
During this process, maintain confidentiality and avoid discussing the matter with others. This ensures you have time to make arrangements, such as securing alternative employment if necessary. Ultimately, hiring a knowledgeable healthcare fraud attorney is essential for a successful outcome.
(Note: While this guidance focuses on Michigan, the principles are applicable nationwide for those facing similar situations.)