Disarrayed Deeds, Dirty Doctors & Deceitful Debits

No one starts off wanting to become a habitual drug user.  Often times it happens from experimentation, peer pressure and after persistent usage addiction.  We are in an Opioid crisis in this country where the addicts can’t even come to the first stage of recovery which is awareness, and when we blog about the topic invariably people write us to tell us to stop tackling Opioid abuse and not to take away their drugs!

Just like no one wants to be an addict, but there’s plenty of them, I like to believe that no one starts off wanting to defraud the government, but there’s plenty of that as well.  Medical Doctors who submit false claims to the federal government could be liable for up to three times the fraud in damages, and people who blow the whistle on dirty doctors could receive up to 30% as a whistleblower award, which could be a considerable sum.  The provisions of the False Claims Act (FCA) provide for that type of recovery, but they also mandate that the whistle blower also known as a relator obtain a qui tam lawyer to file their claim.

So in the spirit of Star Wars which is coming out this week – how do Doctors go to the Dark Side?

Let’s say for example a Doctor in New York is overbilling Medicare by using a wrong code.  That New York Doctor’s False Claims may have started innocently enough with the frustration of the labyrinth of regulations from the government.  They may have continually been rejected for what they believed was rightful billing for a certain code and found out that a similar code pays the same with minimal efforts if they use the right buzz words. Sounds fair?  On a certain sense it may be, but of course, now we have lying on a patient’s charts for billing purposes and less accountability, but perhaps most people would share the Doctor’s frustrations and perhaps the Doctor would seem sympathetic even though he or she is technically falsely billing Medicare.

Let’s then take this a step further and let’s suppose the Doctor has a practice that extends into New Jersey and Pennsylvania and he continues the Medicare Fraud in those states, but is technically staying even with the billing, but then he determines that his Medicare biller can obtain more for the practice if they bill everything through the New York office and the New Jersey False Claims are now moved to New York for a higher level of compensation.  The Doctor justifies this slightly higher level of reimbursement based on the additional time and staff the practice needs to hire to deal with the Medicare and Medicaid regulations.  Sounds fair?  I think this New Jersey, New York and Pennsylvania False Claim would start to offend some, but others might accept the moral rationalization for committing this Medicare and possibly Medicaid Fraud.

Once the Doctor has accepted that he can commit a false claim and feels justified to obtaining more than the correct compensation, the boundary is now set by his or her own need for greed and may justify it other ways, such as the practice is now growing to Illinois and California, and even though he’s overbilling the government, he’s creating jobs, and helping the economy and healing people – but hurting the taxpayer in the process.  Often times once the moral barriers are removed, the floodgates for fraud open up and the fraudulent billing extends to the extent that it can go undetected.

But nothing lasts forever.  There’s that Qui Tam statute, also known as a False Claims Act (FCA) and people who are hired within the practice are governed by what is right, not blind loyalty to the Doctor. People may ask themselves, how do I find the right Qui Tam Lawyer, what is a False Claims Act law firm, are there localized firms such as a New Jersey Whistle Blower Law Firm, do I need a Qui Tam lawyer from each site, for example an Illinois False Claims Act Attorney?  Generally, there are lawyers that focus a part of their practice to handling False Claims Act litigation.  The FCA while potent, requires navigation and commitment.  The whistleblower who has the courage to come forth, stands to receive a whistleblowing award up to 30% of the amount recovered for the government, but there’s work that goes into that such as filing the complaint properly under seal, being prepare for the relator interview and a commitment to see it from start to finish while abiding by the secretive qui tam rules.

When the whistle blower is ready he or she consults with the lawyer and determines there are violations of:

• The False Claims Act (FCA)
• Illinois False Claims Act – (740 ILCS 175/1) (from Ch. 127, par. 4101)
• New Jersey False Claims Act – § 2A:32C-1
• New York False Claims Act – Chapter 56. Of the Consolidated Laws Article XIII. New York False Claims Act § 187. Short title
• Chicago False Claims Act – Chapter 1-22
• New York City False Claims Act – §7-801
• Philadelphia False Claims Act – § 19-3601

Each statute providing for its own proofs, notice and damages.  That’s a litany of litigation for what may have started as a Doctor’s dream to get even, but then twisting it to get ahead.