Medicare Fraud – Not Just A False Claims Act Issue

I recently wrote a series of articles explaining the federal False Claims Act, which allows individual whistleblowers to file suit for fraud on government contracts.  At the time, I mentioned that the most common type of False Claims Act lawsuit involves medical billing fraud. (In fact, Louisiana has a separate state law regarding medical fraud in state contracts.)  As if to emphasize my point, in the last week local newspapers reported two separate criminal convictions for Medicare fraud in Louisiana.

The first article discusses the trial and conviction of six defendants — including four doctors — for a long-running Medicare fraud scheme.  The amount of fraud at issue was an eye-popping $13.6 million over several years.  The month-long trial took place in federal court in the Eastern District of Louisiana, and some of the defendants may spend the rest of their lives in prison.  Such a lengthy trial is unusual, but Medicare fraud cases tend to be complex and require expert testimony about accounting and medical services (which can get expensive – yet another reason why it is beneficial for the government to intervene in a False Claims Act case).  Nonetheless, the core allegations were simple:  the defendants “signed off on home health care orders for patients regardless of whether they actually needed the services,” then charged the government for those unnecessary services.  This is textbook Medicare fraud.

The second report involved a simpler scheme, in which the conspirators simply billed the government for nonexistent medical services.   They submitted “hundreds of fraudulent cases” to Medicare between 2007 and 2009, totaling over $1 million.  One conspirator previously pleaded guilty, and the second was just sentenced to ten months in prison — this after previously serving almost four years in prison for a different Medicare fraud.

Of course, both of these cases were brought for criminal fraud, and were not civil whistleblower lawsuits under the False Claims Act.  However, they emphasize that Medicare fraud is distressingly common and that impressive amounts of money can be in play.  Perhaps most importantly, they show that the government takes allegations of fraud very seriously, both in civil court and in criminal court.

If you would like to report government contract fraud or have any questions about the False Claims Act, call me at (504) 267-0777 or email me here. The initial consultation is always free, and our call is completely confidential and privileged.  False Claims Act lawsuits are filed under seal, and good faith whistleblowers are legally protected against retaliation.