blog home Medical Malpractice Qui Tam Blowing the Whistle on Medicaid Fraud Can Save Lives!

Blowing the Whistle on Medicaid Fraud Can Save Lives!

By Jason Bottlinger on March 14, 2018

Medicaid is a massive government program that provides coverage to millions of low-income and vulnerable patients every year. With any program so large, however, unscrupulous companies take their chances at filing overinflated or blatantly false bills.

An egregious example of this was Kool Smiles, a national children’s dental chain. According to the U.S. Justice Department, Kool Smiles was performing unnecessary procedures—tooth extractions, root canals, or pretend root canals—on their young patients and billing Medicaid. In all, the chain was found to have submitted false claims in 17 states, and ordered to pay back $24 million.

And the bad dental work had a tangible cost. Two children in Yuma, Arizona, died only weeks apart after visiting the same Kool Smiles clinic; one from a preventable infection, the other stopped breathing while getting a filling.

The Medicaid fraud was brought to light by concerned employees, including Robin Fitzgerald, who worked at an Amarillo Kool Smiles branch from 2008 to 2010. “…in over 20 years of working in medicine, she never saw a practice take advantage of their patients like this,” according to KYMA. Fitzgerald and fellow employees became whistleblowers, working with investigators to gather evidence against Kool Smiles.

“Exploiting needy children for financial gain is inexcusable,” said U.S. Attorney John H. Durham for the District of Connecticut, where a separate lawsuit was filed against the same company. The whistleblowers in the federal case received payouts of more than $2 million dollars for helping to end the fraudulent scheme.

This goes to show that one of the best ways people can combat fraud is through being a whistleblower. When it comes to organizations that commit Medicaid fraud, this is not just a matter of money—it can be a matter of life or death.

What Is a Whistleblower?

A whistleblower is someone who sees fraud in a company or organization and reports it to law enforcement or the government agency being defrauded. In most cases, it is someone who works for the company and sees his or her employer breaking the law.

This can be a hard decision for anyone, since it often results in the whistleblower’s life becoming more difficult. In many cases, a whistleblower might spend years gathering evidence from within a company to prove that fraud is going on and providing that evidence to law enforcement. In addition, the company may retaliate against the employee.

As a way to encourage this behavior, the government allows the whistleblower to recover a portion of the financial damages made through fraud by filing a lawsuit.

What Are Whistleblower Lawsuits?

Whistleblower lawsuits, also called qui tam lawsuits, are civil lawsuits in which someone who exposes fraud in a company can sue the guilty parties. For example, a doctor at a hospital notices more and more pressure being put on himself and other doctors to push a certain treatment. The doctor conducts further research and finds that the company operating the hospital is making large profits by pushing this procedure when it is not necessary. He finds documents proving that the hospital is using this to bill Medicaid when cheaper options would be more beneficial for patients. When he reports this information to the government, he becomes a whistleblower. The government can then reclaim money fraudulently taken by the hospital, and the doctor who blew the whistle can file a lawsuit against the hospital for financial damages.

How Do These Lawsuits Help Everyone?

While whistleblower lawsuits can save lives, particularly when Medicaid or Medicare fraud is involved, they also save money for the government and taxpayers. Programs like Medicare and Medicaid are funded through tax money, which means they are paid for by the general public. When a business commits fraud, it is not just taking money from the government—it’s taking money from every United States citizen who pays taxes.

In 2013, for example, almost $6 billion was recovered in lawsuits from businesses that were defrauding the government. This money was returned to those agencies that needed it to help people. A portion of those lawsuits also went to the people responsible for exposing the fraud.

Healthcare businesses, though providing a necessary service, are designed to make money. These companies often receive funding from programs like Medicaid and Medicare to treat those in need. But not all companies are honest. Whistleblower lawsuits can help save lives, and also keep companies in check, because their own employees can monitor their actions and report fraud when it occurs.

If you have a question about filing a whistleblower or qui tam lawsuit, please call Bottlinger Law L.L.C. at (402) 505-8234. We offer a free consultation, and our legal team will be happy to sit down with you and explain the ins and outs of these claims.

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