Do You Suspect Your Delaware Employer or Medical Provider Is Guilty of Medicaid Fraud?
Fraud, waste and abuse of Medicaid funds are estimated to cost taxpayers billions of dollars each year. Delaware Medicaid uses government funds supplied by taxpayers to provide health benefits to individuals and families with limited resources. In 1980, the state of Delaware and the federal government organized the Medicaid Fraud Control Unit (MFCU), designed to protect Delaware residents who take part in the Medicaid program and the taxpayers who support them.
While the MFCU works to investigate and prosecute the illegal use of Medicaid funds, it is up to physicians, billing clerks, sales reps, pharmacists, nurses, EMTs and all other medical providers to report misuse and abuse of Medicaid funds. Health care professionals have access to the inside information critical to identifying violations. These whistleblowers are offered cash rewards, often in the millions of dollars, for evidence leading to successful government recovery of funds. Federal and Delaware law also provides powerful anti-retaliation protection to individuals reporting Medicaid fraud as further incentive to come forward.
If you have knowledge that your employer is submitting false claims to Medicaid, you may be eligible to receive a significant cash award. Don’t hesitate or your claim could be at risk. Contact the Medicaid Fraud Hotline today for a free, immediate and confidential case evaluation.
Review the Various Types of Medicaid Fraud
Reporting Delaware Medicaid Fraud
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What Delaware Laws Apply to Reporting Medicaid Fraud?
The Delaware False Claims and Reporting Act (DFCRA), 6 Del. Code Ann. §§ 1201-1211, enables private citizens to file "qui tam" lawsuits on behalf of the State of Delaware if they have knowledge that an individual or entity is submitting false or fraudulent claims to Medicaid. The DFCRA imposes liability on defendants who knowingly present, or cause to be presented, a false claim for payment to state Medicaid; who knowingly make or use a false statement to collect a fraudulent or false payment; who misappropriate state property; or who conceal, avoid or decrease an obligation to pay or transmit property to the state.
Penalties for violating the DFCRA include treble damages, plus civil penalties ranging from $5,500 to $11,000 per false claim. Defendants who voluntarily disclose violations within 30 days – where no investigation is pending at the time of disclosure – and defendants who cooperate with any investigation into the violations, may have penalties reduced to not less than twice the damages.
What Protections Does Delaware Law Provide for Medicaid Fraud Whistleblowers?
Whistleblower Protections under the Delaware False Claims and Recovery Act
The DFCRA has strong anti-retaliation provisions to protect employees who report or plan to report Medicaid fraud. Forms of employer retaliation prohibited by the DFCRA include discharge, demotion, suspension, threats, harassment, promotion denial and any other discrimination in response to an employee’s disclosure of information regarding DFCRA violations to the state of Delaware.
Under the DFCRA, whistleblowers who are subjected to employer retaliation are entitled to file a claim for all damages essential to “make the employee whole.” Remedies may include:
- Job reinstatement with comparable seniority
- Two times back pay plus interest and benefits
- Reasonable attorneys’ fees and other litigation costs
- Other applicable damages
Whistleblower Protections under the Delaware Public Employees Protection Statute
Delaware Public Employees Protection (DPEP), 29 Del. Code Ann. § 5115, states that no employee of the State, its school districts, or county or municipal government shall be discharged, threatened or otherwise discriminated against because they reported, in a written or oral communication to an elected official, a violation or suspected violation of a law or regulation promulgated under the law of the United States, this State, its school districts, or a county or municipality of this State unless the employee knows that the report is false.
Whistleblower Protections under the Delaware Whistleblower Protection Act
Delaware Whistleblower Protection Act (DWPA), 74 Del. Laws, c. 361, § 1, states that full or part-time employees of any employer (including at-will employees, contract employees, independent contractors, and volunteer firefighters) shall not be discharged, threatened, or otherwise discriminated against regarding the employee’s compensation, terms, conditions, location, or privileges of employment:
- Because the employee, or a person acting on behalf of the employee, reports or is about to report to a public body a violation which the employee knows or reasonably believes has occurred or is about to occur, unless the employee knows or has reason to know that the report is false; or
- Because an employee participates or is requested by a public body to participate in an investigation, hearing, or inquiry held by that public body, or a court action, in connection with a violation as defined in this chapter; or
- Because an employee refuses to commit or assist in the commission of a violation, as defined in this chapter; or
- Because the employee reports verbally or in writing to the employer or to the employee’s supervisor a violation, which the employee knows or reasonably believes has occurred or is about to occur, unless the employee knows or has reason to know that the report is false. Provided, however that if the report is verbally made, the employee must establish by clear and convincing evidence that such report was made.
Under the DWPA, an employee may file a claim for damages for injury or loss caused by each violation, including job reinstatement, payment of back wages, full reinstatement of fringe benefits and seniority rights, expungement of records relating to the disciplinary action or discharge, actual damages, or any combination of these remedies. A court may also award all or a portion of the costs of litigation, including attorneys’ fees.
What Cash Awards Are Available for Reporting Delaware Medicaid Fraud?
The Delaware False Claims and Reporting Act, 6 Del. Code Ann. §§ 1201 et seq., awards whistleblowers anywhere from 15-30% of the financial recovery obtained through a successful settlement or verdict. If the state decides to intervene in the investigation, the whistleblower is entitled to 15-25% of any recovery. In cases where the government declines to intervene, the whistleblower award is increased to between 25-30% of the state’s recovery.
Over $3 billion dollars in False Claims Act government recoveries for the year 2014 were the result of a whistleblower coming forward. For making the decision to report Medicaid Fraud, the government awarded whistleblowers across the nation a total of $435 million that year.
Are there Time Limits on Reporting Delaware Medicaid Fraud?
Under the Delaware False Claims and Reporting Act, 6 Del. Code Ann. §§ 1201 et seq., individuals may file an action reporting Medicaid Fraud in the state of Delaware:
- Within 6 years of the alleged fraudulent act OR,
- Within 3 years after the date when the facts material to the case should have been known, BUT
- With an absolute maximum limitation of 10 years of the alleged fraudulent act – whichever occurs last.
Under the Delaware Public Employees Protection, 29 Del. Code Ann. § 5115, employees who allege employer retaliation must bring a civil action for appropriate injunctive relief, actual damages, or both, within 90 days after the occurrence of the alleged violation.
Under the Delaware Whistleblower Protection Act, 74 Del. Laws, c. 361, § 1, any employee who alleges a violation may bring a civil action for appropriate declaratory relief, or actual damages, or both within 3 years after the occurrence of the alleged violation.
3 Easy Steps to Help you Decide
Whether You Should Report Medicaid Fraud
If you have information concerning Medicaid Fraud in the State of Delaware, contact the Medicaid Fraud Hotline or fill out the online report form. Timing is critical. First-to-file rules allow only the first to report their knowledge to receive a cash award, and statutes of limitations limit the amount of time you have to file a claim.
Delaware Pays Millions in Cash Awards for Information on Medicaid Fraud