A number of health care industry sectors can serve as gateways for defrauding state health care funds, including hospitals, nursing homes, physician practices, pharmaceutical manufacturers, medical device manufacturers to name a few.
Those with inside information on attempts of defrauding state health care programs are the unsung heroes of our nation’s taxpayers and health care system. Reporting Medicaid fraud helps put a stop to dishonest actions and helps the government recover money designated for low-income families and others in need. Federal and state False Claims Acts provide millions in cash awards and job protections offering recourse to those who suffer employer retaliation for coming forward.
If you are aware of Medicaid Fraud occurring in your workplace, your information could entitle you to a substantial cash award. Call now for a no-cost, immediate, completely confidential case evaluation.
Review the Various Types of Medicaid Fraud
Reporting Florida Medicaid Fraud
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What Florida Laws Govern Reporting Medicaid Fraud?
In addition to federal laws like the federal False Claims Act, several Florida state laws apply to reporting Medicaid fraud.
Florida False Claims Act
Like the Federal False Claim Act, the purpose of the Florida False Claims Act (FFCA) is to discourage individuals from knowingly causing or assisting in causing the government to pay false or fraudulent claims, to protect relators from retaliation, and to provide a means of recovery for the state.
The Florida False Claims Act (FFCA), (Fla. Stat. § 68.081 et seq.), allows individuals with information regarding fraud against the state to file "qui tam" lawsuits on behalf of the state of Florida. Provisions of the FFCA make it illegal for individuals and corporations to knowingly present (or cause to be presented) false or fraudulent claims for payment or approval to the State of Florida, misappropriate state property, or deceptively conceal or avoid an obligation to pay the State.
Specifically, the FFCA provides liability for any person who
(a) knowingly presents or causes to be presented to an officer or employee of an agency a false or fraudulent claim for payment or approval;
(b) knowingly makes, uses, or causes to be made or used a false record or statement to get a false or fraudulent claim paid or approved by an agency;
(c) conspires to submit a false or fraudulent claim to an agency or to deceive an agency for the purpose of getting a false or fraudulent claim allowed or paid.
Violating the FFCA results in civil penalties of up to three times the financial harm caused to the State of Florida, plus a fine of between $5,000 and $11,000 for each individual false claim.
Under the FFCA, employees of the state of Florida with information obtained during their employment are not permitted to file a claim under the FFCA – however Florida state employees may file a claim under the federal False Claims Act for those cases involving federal violations.
Claim your cash award. Contact the Medicaid Fraud Hotline Now.
Are Reporters of Florida Medicaid Fraud Protected Under Florida Law?
Both the federal False Claims Act and the FFCA provide strong anti-retaliation protections to those who chose to report Medicaid fraud. The Florida Whistleblower’s Act is also in place to provide protection to those willing to report Medicaid fraud.
Florida False Claims Act
Like the federal False Claims Act, the FFCA also provides anti-retaliation protections for any employee discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment by an employer because of lawful acts done by the employee on behalf of the employee or others in furtherance of an action under the Act, including investigation for, initiation of, testimony for, or assistance in an action filed or to be filed under the Act (Fla. Stat. § 68.088).
Florida Whistleblower’s Act
Enacted in 1986, the Florida Whistleblower’s Act (FWA) (Fla. Stat. § 112.3187) provides protection from retaliatory actions for employees who file a claim against their employer.
Retaliatory actions include the “discharge, suspension, or demotion by an employer of an employee or any other adverse employment action taken by an employer against an employee in the terms and conditions of employment.”
The FWA protects Florida employees from retaliation in response to disclosing:
Any violation or suspected violation of any law, rule, or regulation, committed by an agency or contractor that creates and presents a substantial and specific danger to the public’s health, safety, or welfare.
Any act or suspected act of gross mismanagement, malfeasance, misfeasance, gross waste of public funds, suspected or actual Medicaid fraud or abuse, or gross neglect of duty committed by an employee or agent of an agency or independent contractor.
The FWA can be divided into the public sector and the private sector.
Florida’s private sector FWA prohibits employers from taking retaliatory action against an employee based on the employee engaging in the following three kinds of conduct:
- Disclosing or threatening to disclose information pertaining to the violation of a law, rule or regulation
- Providing information pertaining to the violation of a law, rule or regulation to a state agency, body or agent during an investigation, hearing or inquiry.
- Refusing to participate in the violation of a law, rule or regulation.
Florida’s public sector FWA prohibits agencies and independent contractors from retaliating against employees or other individuals who disclose:
- Improper use of governmental office,
- gross waste of funds, or any other abuse or
- gross neglect of duty on the part of an agency, public officer, or employee
The following are not protected under the FWA:
- Individuals who commit or intentionally participate in the commission of a violation.
- Individuals under custody of the Florida correctional system.
- Individuals who disclose information they know to be false.
Under the FWA, if successful, employees or other individuals may be eligible for:
- Reinstatement to the same position, an equivalent position, or reasonable front pay as alternative relief
- Reinstatement of full fringe benefits and seniority rights
- Compensation for lost wages, benefits, or other lost remuneration
- Payment of attorney’s fees and costs
Am I Eligible For A Cash Award for Reporting Florida Medicaid Fraud?
Under the FFCA, an individual who brings a claim on behalf of the State of Florida is entitled to receive a cash award for their efforts.
For cases joined by the Florida Attorney General, this cash award will fall between 15 and 25% of the total state recovery resulting from the claim, plus attorney’s fees and costs.
For relators who proceed with a claim without the aid of the Florida Attorney General, the cash award will fall between 25 and 30% of the recovery.
The specific amount of cash award is dependent upon the extent to which the relator contributed to the prosecution. If the relator’s inside information is based on previously disclosed public information, or it the relator was involved in the planning or initiation of the fraudulent activities, the court may reduce the cash award amount.
Is There A Statute of Limitations For Reporting Florida Medicaid Fraud?
Under the FFCA, a relator is required to file the complaint within 10 years of the date on which the violation occurred.
Filing a claim under the FWA must be completed within 60 days after the retaliatory actions occurred.
3 Easy Steps to Help you Decide
Whether You Should Report Medicaid Fraud
If you are aware of false or fraudulent billing, documentation or product and service provision regarding Florida Medicaid, contact the Medicaid Fraud Hotline immediately. Act fast. Statutes of limitations apply. Your privacy matters and all information is kept completely confidential.
Tips Resulting In Florida State Recovery Are Awarded Over $1 Million