Our whistleblower and qui tam attorneys will guide you through the process of filing an action under seal or preparing a whistleblower complaint under the SEC and IRS whistleblower programs.
We will guide you through the process of filing an action under the federal False Claims Act and provide representation throughout the course of the litigation, whether your participation is limited to supporting the Government or if you are put in the role of taking the lead in prosecuting a claim on the Government’s behalf.
Our Florida whistleblower law firm is national in scope and results. If you are aware of significant Government fraud anywhere in the United States, we want to help you.
We also handle cases arising under the Florida False Claims Act and other laws that protect state and local governments against fraud.
What is Fraud?
While most of us have heard about fraud, many are unaware of what it actually encompasses. Fraud is a legal term that refers to the use of intentional deception or dishonesty to obtain an unauthorized benefit. While there are both state and federal laws in place that aim to protect people from being taken advantage of in this way, thousands of individuals still find themselves the victims of fraud everyday. Fortunately, it is possible to hold companies and individuals accountable for their use of deceptive or dishonest tactics, so if you were the victim of a fraudulent act, it is important to reach out to an experienced Florida fraud lawyer who can help you seek compensation for your losses.
Types of Fraud
There are a number of different types of fraud, but the most common include:
- Medicare/Medicaid fraud, which occurs when a healthcare provider bills for services that were not provided, charges for unnecessary services or treatment, or pays third parties for patient referrals;
- Military/government fraud, which consists of fraudulent acts in connection with obtaining a government contract, or in regards to federal programs like public housing;
- Embezzlement, which occurs when a person or entity misappropriates assets that were entrusted to them;
- Forgery, which involves the unlawful imitation of an object of value with the intent to deceive and includes offenses such as falsifying contracts or signing someone else’s name on a check;
- Fraudulent financial reporting, which involves intentionally misrepresenting a firm’s financial statements to give investors a false impression of the company’s performance and profitability;
- Identity theft, which involves the unauthorized use of a person’s identifying information for economic gain;
- Money laundering, or concealing the origins of funds obtained illegally through a sequence of transactions and banking transfers;
- Securities fraud, which occurs when an investor is induced to make purchase or sale decisions based on false information; and
- Mail fraud, which involves the use of the U.S. mails to perpetrate a crime of deceit.
Both state and federal law criminalize this type of conduct, so defendants who are convicted of fraud face serious penalties, including jail time, fines, and restitution.
Elements of Fraud
To prove that someone committed fraud, a plaintiff will need to provide a court with convincing proof that:
- The defendant purposely misrepresented a material fact despite knowing that the information was false or deceptive or otherwise intentionally misled the plaintiff;
- The plaintiff relied on the defendant’s misrepresentation; and
- The plaintiff suffered an actual loss as a result of that reliance.
The evidence needed to prove that these elements have been fulfilled can include everything from business records and financial documentation to testimony and complaint letters. Collecting this evidence can, however, be a complicated endeavor, so if you believe that you were the victim of fraud, please call our office to begin investigating your claim.
Reporting Florida Medicare Fraud
Medicare fraud is usually committed by medical practitioners, hospitals, and medical equipment suppliers that claim money from the Medicare program for services that they don’t actually provide. Although it is possible to file a claim against those who commit Medicare fraud, doing so can be difficult, so if you have questions about filing a lawsuit against a healthcare provider or hospital for Medicare fraud, please contact an experienced Florida medicare fraud lawyer today.
What is Medicare Fraud?
Medicare fraud can take a number of different forms, but most often involves:
- Upcoding, which occurs when a healthcare provider bills at a higher code than is permitted;
- Billing for services that aren’t necessary or weren’t even provided;
- Unbundling services, which occurs when a provider submits separate bills for lab services that should actually be billed as a single group;
- Billing non-covered services as covered services; and
- Soliciting, offering, or receiving a kickback in exchange for a referral.
While some hospitals and healthcare providers use these same methods against insurance companies, the reward program authorized by the False Claims Act only issues monetary awards for reports of fraud committed against Medicare programs. This means that if a hospital was upcoding for most of its patients, the reward program would only issue compensation based on the fraud committed specifically against Medicare recipients.
Filing a Whistleblower Complaint
Whistleblowers who have knowledge of Medicare fraud can file a complaint under the False Claims Act, which rewards whistleblowers with between 15 and 30 percent of what the government collects from the at-fault provider. However, to receive a reward, a complainant must hire an attorney to file a lawsuit against the at-fault party. The complaining party will also need to provide the government with details and specific evidence of the fraudulent act. Rewards are collected most often by those who work for the hospital or healthcare provider who committed the fraud.
How to Report Medicare Fraud
Whistleblowers who report Medicare fraud must file a qui tam application under the False Claims Act with the aid of an attorney that contains detailed evidence of the fraudulent activity in question. It’s important to note that while the Office of Inspector General does accept complaints regarding Medicare fraud, they do not provide the complainant with a reward. Instead, whistleblowers should file a complaint directly with a federal district court, which will keep the case “under seal” until the government has completed an investigation, at which point, it will decide whether or not to intervene in the case. If successful, a complainant could receive a reward of between 15 and 25 percent of the amount recovered by the government.
Florida False Claims Act
The federal government recovers billions of dollars in fraudulent billings and overpayments every year under the False Claims Act, which allows private persons to blow the whistle and bring lawsuits on behalf of the government. Yet it is not only the federal government which is constantly being defrauded. The state of Florida has its own False Claims Act mirroring the federal law and providing a way for individuals to sue and help recover fraud against Florida state government entities. The attorneys at Rabin Kammerer Johnson are authorities on the Florida False Claims Act. Read on for more information about this important state law, and contact Rabin Kammerer Johnson for assistance in a Florida False Claims Act whistleblower case.
The Florida False Claims Act (FFCA) can be found in Florida statutes sections 68.081 through 68.092. This law prohibits false or fraudulent claims made to or paid by the “state.” Although originally only applying to executive agencies of the state government, amendments were made to the law so that now “state” is defined more broadly.
Illegal Acts under the FFCA
The FFCA prohibits persons and companies who do business with the state from engaging in many different types of fraudulent activity, including the following (among others):
- Knowingly presenting a false or fraudulent claim for payment or approval
- Knowingly making or using false records or statements material to a false or fraudulent claim
- Knowingly making or using false records or statements material to an obligation to pay or transmit money or property to the state
- Knowingly concealing or knowingly and improperly avoiding or decreasing an obligation to pay or transmit money or property to the state
- Conspiring to do any of the above
In making a false claim, the claim does not always have to be made directly to the government. For instance, a subcontractor could present a false claim to the general contractor, knowing that the subcontractor will be paid with government money. The subcontractor in this instance is guilty of violating the FFCA. Similarly, a subcontractor violates the FFCA when intending to defraud the general contractor on a government contract; intent to defraud the government directly is not required.
Penalties for Violating the FFCA
Those found in violation of the FFCA can be liable to the government for a statutory fine between $5,500 and $11,000 per violation, along with treble damages, or three times the amount of actual financial loss caused to the government.
Procedure for Blowing the Whistle and Filing a Lawsuit under the FFCA
If you are a whistleblower with knowledge of a Florida False Claims Act violation, the first step is to hire a lawyer who knows how to bring a whistleblower case. The lawyer will help you notify the Florida Attorney General and/or the Chief Financial Officer (CFO) of the alleged misconduct. All material evidence and information should be disclosed at this time. A sealed complaint is filed in the Second Judicial Circuit court in Leon County, and the AG or CFO has 60 days to review the matter and decide whether or not to intervene.
If the state intervenes and prosecutes the violator, the whistleblower (also known as the relator) will receive 15 to 25% of any award recovered, depending upon the level of the relator’s participation in the action.
If the state declines to intervene, the relator can pursue the matter on behalf of the government. In this case, the relator will receive 25-30% of any award. This amount can be reduced if the relator was also somehow involved in planning or initiating the wrongful conduct.
