Is Your Pennsylvania Health Care Employer Submitting False Claims to Medicaid?

By funding Medicaid, Pennsylvania taxpayers help provide care for low-income children, adults, elderly and disabled Pennsylvania residents. Unfortunately, dishonest individuals and agencies working in the Pennsylvania health care industry continue to steal hard-earned taxpayer dollars by illegally billing Pennsylvania Medicaid for services never provided, medically unnecessary services, illegal kickbacks, higher quality products than provided and more.

In 2015, the Pennsylvania Medicaid Fraud Control Unit investigated 474 cases of Medicaid fraud, prosecuting 95 criminal convictions and eight civil judgements and settlements. These cases resulted in the government recovering over $11 million in stolen Pennsylvania Medicaid funds. 

Because government resources dedicated to discovering incidents of Pennsylvania Medicaid fraud, waste and abuse are limited, it is up to nurses, physicians, pharmacists, EMT’s, sales representatives and other health care professionals to report knowledge of fraud. If you feel you have knowledge of Pennsylvania Medicaid fraud, you may be entitled to a cash award of over $1 million.

Call the Medicaid Fraud Hotline today for a free, immediate and confidential case evaluation.

Medicaid Fraud Hotline: 888.742.7248 or Report Online

Review the Various Types of Medicaid Fraud

Reporting Pennsylvania Medicaid Fraud

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What Laws Cover Reporting Pennsylvania Medicaid Fraud?

The federal False Claims Act (FCA), 31 U.S.C. §§ 3729 - 3733, enables private citizens who suspect Pennsylvania Medicaid Fraud to file a claim on behalf of the federal government. The FCA offers large cash awards for information leading to successful recovery of government funds and protects whistleblowers from employer retaliation in response to reporting fraud.

The federal FCA is violated by any number of activities that result in the submission of a false or fraudulent claim to Pennsylvania Medicaid, including:

  • Billing for medically unnecessary health care
  • Billing for ineligible patients
  • Billing for upcoded services
  • Billing for patients referred in exchange for kickbacks
  • Billing for care under false certification
  • Unbundling of services
  • Billing for services not provided
  • Double billing by a single provider
  • Duplication of billing by more than one provider
  • Billing for costs not covered, including personal expenses or marketing
  • False statements used to enter the Medicaid program
  • Marketing products for off-label, FDA unapproved uses
  • Billing for care based on inappropriate diagnosis
  • Billing for services or products involving false or fraudulent documents
  • Billing for unsafe or substandard quality products or services

No proof of intent to defraud the Pennsylvania Medicaid program is required. The violator must simple have actual knowledge of the information and then act in deliberate ignorance of the truth or falsity of the information or act in reckless disregard of the truth or falsity of the information.

Persons who violate the FCA are liable for a civil penalty of between $10,781.40 and $21,562.80 per false claim, plus three times the amount of damages sustained by the government because of the act of the person or agency and the costs of any civil action brought to recover the damages.

Medicaid fraud robs Pennsylvania taxpayers of millions each year, depriving those in need and increasing the cost of health care for everyone. 

The Federal False Claims Act provides whistleblowers with large cash awards for blowing the whistle on Pennsylvania Medicaid Fraud. Whistleblowers can also seek remedies for employer retaliation in response to reporting fraud. If you feel you have knowledge of Pennsylvania Medicaid fraud, you may be entitled to a cash award of over $1 million. Call today for a free, immediate and confidential case evaluation.

Medicaid Fraud Hotline: 888.742.7248 or Report Online

Are Whistleblowers Protected From Employer Retaliation When Reporting Pennsylvania Medicaid Fraud?

Yes. Under the federal False Claims Act (FCA), 31 U.S.C. §§ 3729 - 3733, any employee, contractor or agent who is discharged, demoted, suspended, threatened, harassed or discriminated against as a result of any lawful act performed in an effort to stop a violation of the FCA, is entitled to all relief necessary to make the employee, contractor or agent whole.

Whistleblowers who suffer employer retaliation may file a claim to seek remedies including:

  • Job reinstatement with the same seniority as if the retaliation had not occurred
  • Twice the amount of lost compensation
  • Interest on the lost compensation
  • Any special damages sustained as a result of the retaliation
  • Compensation for expenses, costs and attorney’s fees.

If you have been harassed, demoted, fired, threatened or otherwise discriminated against by your employer for reporting or planning to report Pennsylvania Medicaid fraud, you may be eligible to file a claim for damages. Timing is critical. Don’t hesitate to file your claim. Call the Medicaid Fraud Hotline now for a free, no-obligation case evaluation.

Medicaid Fraud Hotline: 888.742.7248 or Report Online

What Cash Awards Are Offered for Reporting Pennsylvania Medicaid Fraud?

Under the federal False Claims Act (FCA), 31 U.S.C. §§ 3729 - 3733, if the government choses to intervene in an action, the whistleblower is entitled to receive between 10% and 25% of any recovery, based on his or her contribution to the conduct of the action, the originality of the whistleblower’s information and other criteria.

If the government does not intervene in the action, the whistleblower is entitled to receive between 25% and 30% of any recovery, as the court determines reasonable.

If the action leads to government recovery, the whistleblower is also entitled to reasonable expenses that the court finds were necessarily incurred, including costs, attorney’s fees and fees for expert consultants or witnesses.

Fighting back against Pennsylvania Medicaid Fraud is a crucial step in safeguarding the state’s health care programs for future generations. If you suspect your Pennsylvania health care employer is guilty of Medicaid Fraud, you are protected by federal whistleblower laws and may be entitled to a substantial cash award for your information. Contact the Medicaid Fraud Hotline Now.

Medicaid Fraud Hotline: 888.742.7248 or Report Online

Are There Time Limits on Reporting Pennsylvania Medicaid Fraud?

According to the federal False Claims Act (FCA), 31 U.S.C. §§ 3729 - 3733, a whistleblower action must be commenced:

  • Within 3 years of the date on which the government discovers, or reasonably should have discovered, the fraudulent activity, or
  • Within 6 years after the fraudulent activity occurred, whichever occurs later, but
  • In no event more than 10 years after the fraudulent activity occurred

A civil action brought pursuant under the FCA anti-retaliation provision may not be brought more than 3 years after the date on which the retaliation occurred.

The government’s ability to recover stolen taxpayer dollars is largely dependent on whistleblowers coming forward. The U.S. government recovered nearly $3 billion dollars in 2014 as a result of whistleblowers reporting health care fraud. These whistleblowers were awarded over $435 million in cash as a result of their disclosures. If you have information of Pennsylvania Medicaid Fraud, call today and discover if you are eligible for a whistleblower cash award.

Medicaid Fraud Hotline: 888.742.7248 or Report Online

2 Easy Steps to Help you Decide

Whether You Should Report Medicaid Fraud

If you have information regarding Medicaid Fraud in the State of Pennsylvania, contact the Medicaid Fraud Hotline or fill out the online report form. Remember, you must be the FIRST to report to secure your role as whistleblower and be eligible for a cash award. Statutes of limitations apply.

Over $1 Million in Cash Awards for Tips Leading to Government Recovery
Medicaid Fraud Hotline: 888.742.7248 or Report Online