Is Your Louisiana Employer or other Medical Provider Guilty of Medicaid Fraud?
Medicaid Fraud is illegal. Hospitals and medical professionals who defraud Louisiana Medicaid steal valuable dollars from Louisiana taxpayers and take quality care services away from families and individuals who rely on Louisiana Medicaid for their health care needs.
Louisiana’s Medicaid Fraud Control Unit is committed to protecting Louisiana’s health care resources and prosecutes criminals who steal taxpayer dollars and compromise Louisiana health care programs. In 2015, Louisiana’s Medicaid Fraud Control Unit obtained 73 convictions and 25 civil settlements or judgements – recovering nearly $18 million is stolen state health care funds.
These figures rely heavily on individuals working in the health care arena. The effectiveness and impact of government resources increase substantially when doctors, nurses, pharmacists and others in the position to gain inside information on Medicaid fraud bring their knowledge to the forefront. Louisiana State and federal laws provide whistleblowers with powerful protections and impressive cash incentives to report fraudulent activity.
If you have information regarding Medicaid Fraud, you may be entitled to a significant cash award. Call today for a free, immediate and confidential case evaluation.
Review the Various Types of Medicaid Fraud
Reporting Louisiana Medicaid Fraud
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What Louisiana Laws Apply to Reporting Medicaid Fraud?
The Louisiana Medical Assistance Programs Integrity Law (LMAPIL) (La. Rev. Stat. Ann. §§6:438.1 et seq.) enables private citizens to file a claim on behalf of Louisiana State regarding illegal kickbacks or false claims submitted to Louisiana Medicaid. The LMAPIL provides protection against employer retaliation and pays cash awards for claims that lead to successful government recovery of stolen funds.
Under the LMAPIL, a “false or fraudulent claim” is any claim for goods, items, devices, supplies or services which the health care provider or his billing agent submits knowing the claim to be false, fictitious, untrue, or misleading in regard to any material information. “Knowing” means that the person has actual knowledge of the information or acts in deliberate ignorance or reckless disregard of the truth or falsity of the information.
The LMAPIL makes it a crime to:
- knowingly present or cause to be presented a false or fraudulent claim.
- knowingly engage in misrepresentation to obtain, or attempt to obtain, payment from medical assistance programs funds.
- knowingly make, use, or cause to be made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the medical assistance programs.
- conspire to defraud, or attempt to defraud, the medical assistance programs through misrepresentation or by obtaining, or attempting to obtain, payment for a false or fraudulent claim.
- knowingly submit a claim for goods, services, or supplies which were medically unnecessary or which were of substandard quality or quantity.
- knowingly make, use, or cause to be made or used a false, fictitious, or misleading statement on any form used for the purpose of certifying or qualifying any person for eligibility for the medical assistance programs or to receive any good, service, or supply under the medical assistance programs which that person is not eligible to receive.
Under the LMAPIL, no unauthorized person, or no authorized person for an unauthorized purpose, shall obtain a recipient list, number, name, or any other identifying information, nor shall that person use, possess, or distribute such information.
If a health care provider operating under a voucher system under Louisiana Medicaid fails to provide medically necessary goods, services, or supplies or goods, services, or supplies which are of substandard quality or quantity to a recipient, and those goods, services, or supplies are covered under the managed care contract or voucher contract with Louisiana Medicaid, such failure also constitutes a violation of the LMAPIL.
The LMAPIL also makes it a crime to solicit, receive, offer, or pay any remuneration, including but not limited to kickbacks, bribes, rebates, or bed hold payments, directly or indirectly, overtly or covertly, in cash or in kind, for the following:
- In return for referring an individual to a health care provider, or for referring an individual to another person for the purpose of referring an individual to a health care provider, for the furnishing or arranging to furnish any good, supply, or service for which payment may be made, in whole or in part, under the medical assistance programs.
- In return for purchasing, leasing, or ordering, or for arranging for or recommending purchasing, leasing, or ordering, any good, supply, or service, or facility for which payment may be made, in whole or in part, under the medical assistance programs.
- To a recipient of goods, services, or supplies, or his representative, for which payment may be made, in whole or in part, under the medical assistance programs.
- To obtain a recipient list, number, name, or any other identifying information.
False claims submitted to Louisiana Medicaid are subject to three times the actual damages incurred by the state, plus civil fines. Violation is also grounds for denial or revocation of Louisiana Medicaid enrollment.
Regarding illegal kickbacks, the LMAPIL allows the state to recover three times the amount of illegal kickbacks or $10,000 per violation, whichever is more.
If the claim involves a voucher program, damages are determined from that voucher program. Otherwise, damages equal the difference between what Louisiana Medicaid paid or would have paid and the amount that should have been paid but for the false claim.
The court may order the forfeiture of property to satisfy recovery when the property constitutes or was derived directly or indirectly from gross proceeds traceable to the violation. If the property was transferred to a third party to avoid paying of recovery, or in an attempt to protect the property from forfeiture, the court may order the third party to forfeit the transferred property.
Should the parties agree to settle, at a minimum, the settlement shall ensure that the recovery covers the estimated loss sustained by Louisiana Medicaid.
Doctors, nurses, pharmacists, EMT’s and other health care professionals who aim to profit from Louisiana Medicaid through corrupt acts are stealing from Louisiana taxpayers and robbing vulnerable Louisiana residents of their most basic care needs. If you suspect your Louisiana employer or other medical provider is committing Louisiana Medicaid fraud, report it now. You may be entitled to a significant cash award. Call today for a free, immediate and confidential case evaluation.
Does Louisiana Law Protect Those Reporting Medicaid Fraud?
Whistleblower Protections under the Louisiana Medical Assistance Programs Integrity Law
Under the Louisiana Medical Assistance Programs Integrity Law (LMAPIL) (La. Rev. Stat. Ann. §§6:438.1 et seq.), no employee shall be discharged, demoted, suspended, threatened, harassed, or discriminated against in any manner in the terms and conditions of his employment because of any lawful act engaged in by the employee or on behalf of the employee in furtherance of any action taken in regard to a health care provider or other person from whom recovery is or could be sought.
Such an employee may bring an action seeking any and all relief against his employer or the health care provider for his injury to which he is entitled under state or federal law. Relief may include:
- Reinstatement of your position with comparable seniority as you would have but for the discrimination
- Two times the amount of any back pay lost during change in position
- Interest on any back pay lost during change in position
- Reasonable attorneys’ fees and other litigation costs incurred
- Possible compensation for other damages directly resulting from the discrimination
Whistleblower Protections under the Louisiana Whistleblower Law
Under the Louisiana Whistleblower Law, La. Rev. Stat. Ann. § 23:967, an employer shall not take reprisal against an employee who in good faith, and after advising the employer of the violation of law:
- discloses or threatens to disclose a workplace act of practice that is in violation of state law,
- provides inormation to or testifies before any public body conducting an investigation, hearing, or inquiry into any violation of law, or
- objects to or refuses to participate in an employment act or practice that is in violation of law.
"Reprisal" includes termination, layoff, loss of benefits, or any discriminatory action the court finds was taken as a result of an action by the employee.
An employee may file a civil action against any employer who engages in a practice prohibited by the Louisiana Whistleblower Law and may recover damages, reasonable attorney's fees, and court costs. Damages may include compensatory damages, back pay, benefits, reinstatement, reasonable attorney fees, and court costs resulting from the reprisal.
What Cash Awards Are Available for Reporting Louisiana Medicaid Fraud?
Under the Louisiana Medical Assistance Programs Integrity Law (LMAPIL) (La. Rev. Stat. Ann. §§6:438.1 et seq.), whistleblowers are entitled to 15% to 25% of the total recovery when the government has opted to intervene in that case, or 25% to 30% of the total recovery for a case the government opts not to intervene.
In making a determination of award to the qui tam plaintiff the court shall consider the extent to which the qui tam plaintiff substantially contributed to investigations and proceedings related to the qui tam action.
In addition to all other recovery to which he is entitled and if he prevails in the qui tam action, the qui tam plaintiff shall be entitled to an award against the defendant for costs, expenses, fees, and attorney fees, subject to review by the court using a reasonable, necessary, and proper standard of review.
Together, we can recover stolen funds taken through fraud, waste and abuse in the Louisiana Medicaid program. To report suspected fraud of the Louisiana Medicaid Program, call the Medicaid Fraud Hotline now.
What is the Louisiana Statute of Limitations on Reporting Medicaid Fraud?
Under the Louisiana Medical Assistance Programs Integrity Law (LMAPIL) (La. Rev. Stat. Ann. §§6:438.1 et seq.), the qui tam complaint and written disclosure of substantially all material evidence and information must be filed within one year of the date the qui tam plaintiff knew or should have known of the information forming the basis of the complaint.
All actions brought for false claims violations under the LMAPIL must be instituted within ten years of the date upon which the alleged violation occurred.
3 Easy Steps to Help you Decide
Whether You Should Report Medicaid Fraud
If you have information regarding Louisiana Medicaid Fraud, contact the Medicaid Fraud Hotline or fill out the online report form. Timing is critical - you must be the first to report the knowledge to secure your role as whistleblower and be eligible for a cash award. Statutes of limitations may limit your time to file a claim.
Over $1 Million in Cash Awards for Tips Leading to Government Recovery