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Healthcare Fraud Whistleblower Attorneys Helping Clients Win

Brewer & Pritchard, P.C. will put experience and resources to work for you

Healthcare fraud costs taxpayers billions of dollars every year and harms the poor and elderly who are denied services. This type of wrongdoing is a crisis that seems to be growing, as clinics, hospitals and doctors look for profit-boosting methods that cross the line into criminal behavior.

Medical or healthcare fraud is a federal offense that is addressed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Someone convicted of such fraud may face up to 10 years in prison as well as substantial fines.

What's the best way to detect and prevent healthcare fraud? Whistleblowers. The federal government takes these cases extremely seriously. Under the False Claims Act, people who are aware of healthcare fraud can file qui tam lawsuits. In legal terms, these whistleblowers are known as relators - people who bring a lawsuit regarding the healthcare fraud or abuse. To learn more about the terms and to find answers to other questions, visit Healthcare Fraud FAQs.

Representing whistleblowers who want to do the right thing

At Brewer & Pritchard, our attorneys represent whistleblowers who step forward and shine a light on wrongdoing. We are based in Houston, Texas and handle cases statewide. Reporting healthcare fraud not only can stop unscrupulous behavior, but such action can be financially rewarding. Whistleblowers in healthcare fraud lawsuits may be entitled to receive between 15 percent and 30 percent of the government's recovery.

The types of fraud in the healthcare industry cover a wide range. Some of the most common types involve:

  • Medicare fraud - The federal health insurance program that covers individuals 65 or older and certain younger people with disabilities. If you suspect Medicare fraud, contact us immediately.
  • Medicaid fraud - The federal and state program that provides health coverage to people with limited income and resources. We handle these false claims act cases with discretion.
  • TRICARE fraud - The healthcare program for the United States Department of Defense Military Health System. Talk to us today. Your consultation is free and confidential.

Other types of fraud and abuse may involve:

  • Part D Fraud - Medicare Part D is the prescription drug benefit, a taxpayer funded program that subsidizes the cost of prescription medications and prescription drug insurance premiums
  • Pharmaceutical Fraud - This type of abuse typically involves fraudulent claims by drug manufacturers. It often involves pricing, billing and marketing schemes that violate federal and state False Claims Acts as well as other federal and state laws.

Who reports healthcare fraud?

The following professionals typically may discover healthcare fraud occurring and may step forward as whistleblowers:

  • Medical professionals such as doctors, nurses, pharmacists, researchers and people involved in selling medical drugs and devices
  • Healthcare administrators including hospital administrators
  • Accountants, benefits coordinators, coding specialists and financial officers

Examples of fraudulent actions

The following are some examples of healthcare fraud:

  • Phantom billing
  • Upcoding - Billing for more expensive versions of similar procedures
  • Unbundling - Submitting bills piecemeal to maximize the reimbursement for a single test or procedure.
  • Falsifying the services provided
  • Providing unnecessary treatment
  • Billing for services that were never performed
  • Billing for equipment and supplies that were never purchased
  • Bribery or illegal kickbacks
  • Off-label marketing of drugs (marketing drugs or devices for non-approved purposes)
  • Inflating prices of pharmaceutical products

How can a lawyer help if I want to be a whistleblower?

Healthcare fraud schemes can be complicated. If you suspect fraud or abuse, it's understandable that you may be concerned about speaking out. You may be concerned about your job security and your future prospects for employment. At Brewer & Pritchard, our attorneys can help you every step of the way. We will help you file the claim and make sure your rights are fully protected. Call 1-800-445-8710 for a free case consultation today.