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Department of Justice Intervenes in Medicaid Fraud Cases

The Department of Justice recently announced that it was intervening in eight False Claims Act lawsuits that had been brought against Health Management Associations (HMA). The lawsuits were filed under qui tam provisions of the False Claims Act, which make it possible for private parties to sue on the government's behalf in cases where defendants defrauded the government of money. A Medicaid fraud attorney can help whistleblowers when they suspect Medicaid fraud to file such a lawsuit. untitled-1334367-m

The False Claims Act, which allows whistleblowers to receive a share of the money they help the government to recover, allows for the government to intervene in all claims. However, it is relatively rare for the government to do so. When the Department of Justice or other government agencies get involved, that usually means that the chances of a successful lawsuit are greater.

What Government Intervention Means in Qui Tam Cases

The False Claims Act stipulates that qui tam cases are sealed for a period of 60 days. However, courts frequently extend the seal multiple times in order to give the government sufficient time to investigate the allegations of fraud. Government investigations can take months or years, and the government needs time to determine if it wishes to join the case.

Governments may sometimes request that the court partially lift the seal on qui tam cases in order to try to reach a potential settlement with the defendant accused of fraud. A defendant found guilty under the False Claims Act could be required to pay three-times the amount of losses incurred by the government as well as penalties for each of the false claims made.

The majority of successful qui tam cases settle outside of court, rather than through a trial. If a settlement occurs after the government intervenes, the whistleblower is typically entitled to between 15 and 25 percent of the money recovered while in cases where the government does not intervene, then the whistleblower may recover as much as 30 percent of the money recovered.

Why the Government is Intervening in the Medicaid Fraud Cases

The Government has decided to intervene in the Medicaid fraud cases against HMA as part of ongoing efforts to combat health care fraud. The Health Care Fraud Prevention and Enforcement Action Team (HEAT) was announced by the Attorney General and the Health and Human Services Secretary in 2009 and the partnership makes it easier for the departments to focus their efforts on fighting fraud.

The Government investigation revealed evidence indicating that the lawsuit against HMA may have merit. The suits allege that corporate directors exerted pressure on doctors in the emergency departments of 71 hospitals in 15 states to admit patients regardless of necessity in order to generate inpatient payments.

HMA is also accused of paying kickbacks in the form of bonuses or awarded contracts to physician groups in order to encourage the doctors to admit patients without justification. HMA may also have paid kickbacks for referrals, including providing office space and direct payments in exchange for physician practice groups referring patients to HMA hospitals.

Contact a Medicaid fraud attorney if you believe you have evidence of fraud. Call Brewer & Prichard P.C. today at 800-445-8710  or visit http://www.bplaw.com to schedule a consultation.