Mississippi Lawyer Blog

A whistleblower is loosely defined as a person who reports to the government the conduct of a company that is either illegal or dishonest. Of course you could have a whistleblower who reports to the government on improper or illegal conduct by employees in government. Whistleblowers are protected under the False Claims Act, the Sarbanes-Oxley Act and many other federal laws. In fact there is not one law governing false claims or improper conduct by businesses or government but many laws depending on the type of fraud or waste.

The various federal and in some instances state laws that are enacted to protect whistleblowers do not always work perfectly. There are many reported cases where companies and government officials retaliated against the employee who reported improper or wrongful conduct and the employee had to go to court to protect his/her job. I do think that this area of the law is improving and we are witnessing much more employee protection than ever before in this country. There is actually an Office of Whistleblower Protection Program. One of the attractive features of many of the whistleblower laws is that they offer a financial incentive for reporting on departments in the government or businesses that engage in improper waste, spending, or violate laws. For example under the Dodd-Frank Wall Street Reform and Consumer Protection Act (2010) the Securities and Exchange Commission can provide money payments for people who report violations of security laws.

The term "qui tam" is also heard or written about in connection with a whistleblower action. Qui Tam is part of the False Claims Act which permits a private citizen with the help of an attorney to file a lawsuit against any company or person who may have committed fraud upon the United States Government. Once the lawsuit is filed and the government is notified, the government has the right to intervene and become a party to the lawsuit. Some of the "qui tam" whistleblower lawsuits have earned citizens millions of dollars for the fraud they reported.

You usually hear of large monetary awards in qui tam lawsuits or whistleblower actions involving medical fraud and waste. The Obama administration has made uncovering and preventing fraud in the health care field one of its priorities. Here are just a few of the major awards: JP Morgan paid $45 million to settle a whistleblower lawsuit alleging it charged veterans hidden fees in mortgage refinancing; BOA whistleblower gets $1 million;; Dynacorp agrees to pay $7.7 million in whistleblower case. At Coxwell & Associates we have helped people report medical fraud and abuse. The healthcare costs in this nation are rising astronomically. While lawsuits are blamed by big business and the insurance industry, the amount of money lost to fraud and waste is far in excess of the cost of medical negligence cases. Payments to people who have been injured by medical errors or negligence in this country amounts to less than 1% of the costs of medical care costs but medical waste and fraud is estimates at $700 billion a year. .

If you have knowledge of fraud or waste in government contracts, over-billing to the government in medical care cases, improper charges in mortgage cases, violations of the law dealing with securities do not hesitate to call and schedule an appointment with one of our attorneys. We are willing to help you investigate and explore the possibility of filing a whistleblower or qui tam case.

Continue reading "Whistleblowers Help Keep Businesses and Government Honest" »

On February 11, 2011, I wrote a blog about how Medicare fraud was one of the top priorities of the federal government. On February 18, 2011, the feds announced a nationwide Medicare fraud crackdown resulting in hundreds of arrests and $225 million in fraud. Here is the story.

A Medicare fraud investigation has led to the arrest of 111 medical professionals and uncovered more than $225 million in bogus bills and claims. The investigation was brought to light on Thursday after the Medicare Strike Force announced the indictments on Thursday.

The Medicare Task Force is made up of more than 700 law enforcement agents from the FBI, U.S. Health and Human Services Office, and various state and local agencies throughout the country. Since their start in 2007, the task force has charged nearly 1,000 people with damages worth more than $2.3 billion.

The defendants in Thursday's indictments are facing charges ranging from money laundering and identity theft to conspiracy. United States Attorney General Eric Holder said on Thursday that the operation has been a success:

"Through this operation, we have identified and shut down a variety of large-scale fraud offenses. We have safeguarded precious taxpayer dollars."

"And we have helped to protect our nation's most essential health care programs--Medicare and Medicaid--which provide critical assistance to the most vulnerable among us: seniors, people with disabilities, and low-income Americans."

Continue reading "Prediction Accomplished: Huge Nationwide Medicare Fraud Bust. Is Mississippi next?" »

Prosecuting health care fraud is a top priority for the federal government and it should be. Fraud and abuse of taxpayers money cannot be toloerated. News stories abound about federal government fraud enforcement activities against hospitals, clinical laboratories, durable medical equipment suppliers, hospices, and home health agencies. Based on recent legislation to enhance enforcement capabilities, there is reason to expect even more government enforcement activity in the future. While federal fraud investigations and enforcement actions against individual physicians have been isolated thus far, physicians and their practices are not immune to such government actions. Therefore, physicians and others involved in providing patient care need to know how to comply with the federal laws to guard against potential liability in fraud enforcement actions.

However, there are numerous cases which the government calls "fraud" which simply are mistakes. We recently defended a man charged with health care fraud in federal court in Hattiesburg, Mississippi. The government alleged that he had been improperly billing for 4 years and charged him criminally. However, the proof at trial showed that Medicare was aware of our client's billing problems very early on but continued to allow him to submit improper bills. Instead of picking up the phone and simply advising our client of his errors, they continued to allow him to bill and be paid over $16 million in taxpayer funds! Our theory was that the Government simply wanted to build their case against our clients by allowing him to continue to bill.

Medicare, through its private insurance company "contractors, has a duty to educate providers. Medicare regulations are complex and change monthly. Medicare has set up "call in centers" which allow providers to call and ask questions concering billing, coverage, etc. However, if you use these "call in centers" take their answers with a grain of salt. A GAO study (Government Accounting Office) showed that out of 300 calls made to the "call in centers" only 4 percent were answered correctly! So what if you are a provider who calls in, gets incorrect answers, and then submits a bill to Medicare based on this information which proves to be wrong? You will have a difficult time proving the communication with the "call in center" unless you document the conversation in writing.

Continue reading "Health Care Fraud and Abuse in Mississippi" »