Do You Have Knowledge of Massachusetts Medicaid Fraud?
Many deceitful and corrupt health care industry professionals conspire to dodge Massachusetts Medicaid rules and regulations in an effort to pocket taxpayer dollars for themselves. Every Massachusetts taxpayer pays for the crime of Massachusetts Medicaid fraud through the loss of indispensable government services and resulting tax increases.
In 2015 alone, Massachusetts Medicaid Fraud Control Unit (MFCU) investigated over 502 reports of fraud, waste and abuse, resulted in 10 criminal convictions and 21 civil settlements and judgements, recovering over $17.5 million in stolen taxpayer dollars for the state of Massachusetts. These recoveries are often due to the reports of whistleblowers – health care professionals who report knowledge of fraud.
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 Massachusetts Medicaid Fraud
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What Massachusetts Laws Apply to Reporting Medicaid Fraud?
The Massachusetts False Claims Act (MFCA), Mas. Gen. Law. Ch. 12, §§ 5A-5O, allows private citizens to file a whistleblower, or ‘qui tam,’ lawsuit on behalf of the State of Massachusetts when they suspect an entity is submitted false claims to a government program. The whistleblower is entitled to protection from employer retaliation and a percentage of any government recovery.
The MFCA is violated by any person who:
- knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval;
- knowingly makes, uses or causes to be made or used a false record or statement material to a false or fraudulent claim;
- conspires to commit a violation of this subsection;
- has possession, custody or control of property or money used, or to be used, by the government, and knowingly delivers, or causes to be delivered, less than all of that property or money;
- is authorized to make or deliver a document certifying receipt of property used, or to be used, by the government, and with the intent of defrauding the government, makes or delivers the receipt without completely knowing that the information on the receipt is true;
- knowingly buys, or receives as a pledge of an obligation or debt, public property from an officer or employee of the government who may not lawfully sell or pledge such property;
- enters into an agreement, contract or understanding with a government official knowing the information contained therein is false;
- knowingly makes, uses or causes to be made or used a false record or statement material to an obligation to pay or to transmit money or property to the government, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the government; or
“Knowing” or “Knowingly” means possessing actual knowledge of relevant information or acting with deliberate ignorance of the truth or falsity of the information or acting in reckless disregard of the truth or falsity of the information. No proof of specific intent to defraud is required.
Individuals who violate the MFCA are liable to the State of Massachusetts for a civil penalty of between $5,500 and $11,000 for each violation, plus three times the amount of damages sustained by the state and the costs of the civil action brought to recover a penalty or damages.
Because whistleblower knowledge of Massachusetts Medicaid fraud is key, the Massachusetts False Claims Act awards whistleblowers with 10% to 30% of the total government recovery. Massachusetts physicians, nurses, medical equipment companies, pharmacists, dentists, EMTs and other health care professionals who provide services to Massachusetts Medicaid beneficiaries are in a prime position to identify and report fraud.
Does Massachusetts Law Provide Protection For Those Reporting Medicaid Fraud?
Under the Massachusetts False Claims Act (MFCA), Mas. Gen. Law. Ch. 12, §§ 5A-5O, no employer, contractor or agent may discharge, demote, suspend, threaten, harass or in any other manner discriminate against an employee, contractor or agent because of lawful acts done by the employee, contractor, agent or a person associated with the employee, contractor or agent in furtherance of an MFCA action or other efforts to stop a violation of the MFCA.
In addition, no employer may:
- make, adopt or enforce any rule, regulation or policy preventing an employee, contractor or agent from disclosing information to a government or law enforcement agency or from acting to further efforts to stop one or more violations of the MFCA.
- require as a condition of employment that any employee, contractor or agent agree to, accept or sign an agreement that limits or denies the rights of such employee, contractor or agent to bring an action or provide information to a government or law enforcement agency pursuant to the MFCA.
Under the Massachusetts Whistleblower Law, Mas. Gen. Law. Ch. 149 § 185, an employer may not take any retaliatory action against an employee because the employee:
- Discloses, or threatens to disclose to a supervisor or to a public body an activity, policy or practice of the employer, or of another employer with whom the employee's employer has a business relationship, that the employee reasonably believes is in violation of a law, or a rule or regulation promulgated pursuant to law, or which the employee reasonably believes poses a risk to public health, safety or the environment;
- Provides information to, or testifies before, any public body conducting an investigation, hearing or inquiry into any violation of law, or a rule or regulation promulgated pursuant to law, or activity, policy or practice which the employee reasonably believes poses a risk to public health, safety or the environment by the employer, or by another employer with whom the employee's employer has a business relationship; or
- Objects to, or refuses to participate in any activity, policy or practice which the employee reasonably believes is in violation of a law, or a rule or regulation promulgated pursuant to law, or which the employee reasonably believes poses a risk to public health, safety or the environment.
''Retaliatory action'' means the discharge, suspension or demotion of an employee, or other adverse employment action taken against an employee in the terms and conditions of employment.
The Massachusetts Whistleblower Law requires that an employee bring the violation to the attention of a supervisor of the employee by written notice and afford the employer a reasonable opportunity to correct the activity, policy or practice before filing a claim.
An employee may file a claim without reporting internally to a supervisor first if:
- the employee is reasonably certain that the activity, policy or practice is known to one or more supervisors and the situation is emergency in nature;
- reasonably fears physical harm as a result of the disclosure provided;
- or makes the disclosure to a public body for the purpose of providing evidence of what the employee reasonably believes to be a crime.
Whistleblowers Are Entitled To Remedies When Subjected to Employer Retaliation
Under the MFCA, whistleblowers who experience workplace retaliation are entitled to all damages essential to “make the employee whole.” These remedies include:
- reinstatement with the same seniority status the employee, contractor or agent would have had but for the discrimination
- twice the amount of back pay
- interest on the back pay
- compensation for any special damages sustained as a result of the discrimination
- litigation costs and reasonable attorneys' fees
Under the Massachusetts Whistleblower Law, the court may:
- issue temporary restraining orders or preliminary or permanent injunctions to restrain continued violation of this section;
- reinstate the employee to the same position held before the retaliatory action, or to an equivalent position;
- reinstate full fringe benefits and seniority rights to the employee;
- compensate the employee for three times the lost wages, benefits and other remuneration, and interest thereon; and
- order payment by the employer of reasonable costs, and attorneys' fees.
What Cash Awards Are Available for Reporting Massachusetts Medicaid Fraud?
Under the Massachusetts False Claims Act (MFCA), Mas. Gen. Law. Ch. 12, §§ 5A-5O, a whistleblower who files the initial complaint is entitled to the following amounts if the state prevails in the action:
- If the state choses to intervene, the whistleblower is entitled to between 15% and 25% of the proceeds of the action or settlement, plus reasonable attorneys’ fees and an amount to cover the expenses and costs of bringing the action.
- If the state opts not to intervene, the whistleblower is entitled to between 25% and 30% of the proceeds of the action or settlement, plus reasonable attorneys’ fees and an amount to cover the expenses and costs of bringing the action.
Final award amounts are calculated based upon the significance of the information provided by the whistleblower and the extent of the role the whistleblower plays in the investigation and advancing the case to litigation.
A whistleblower’s decision to report fraud directly influences the government’s ability to prosecute cases and stop Massachusetts Medicaid Fraud. Massachusetts Medicaid provides health care services for less fortunate, low-income children, adults and elderly patients who could otherwise not afford care. The Massachusetts government carefully distributes tax dollars to ensure adequate funding of such programs. When these funds are stolen or abused, every Massachusetts resident suffers. Help put a stop to Massachusetts Medicaid fraud. Call now for a free, no-obligation case evaluation.
What is the Massachusetts Statute of Limitations on Reporting Medicaid Fraud?
Under the Massachusetts False Claims Act (MFCA), Mas. Gen. Law. Ch. 12, §§ 5A-5O, a whistleblower lawsuit must be brought:
- within 6 years after the date on which the violation is committed, or
- within 3 years after the date when facts material to the right of action are discovered or reasonably should have been discovered, and
- no longer than 10 years after the date on which the violation is committed.
A civil action under the anti-retaliation provisions of the MFCA may not be brought more than 3 years after the date the retaliation occurred.
A civil action under the Massachusetts Whistleblower Law may not be brought more than 2 years after the date the retaliation occurred.
The federal and state government pays a significant cash award, often hundreds of thousands to millions of dollars, for reporting Massachusetts Medicaid fraud when an investigations leads to government recovery. In addition, Massachusetts whistleblower laws give anti-retaliation protections to individuals who step forward and report misconduct. If you feel you have knowledge of Massachusetts Medicaid fraud, don’t hesitate to contact the Medicaid Fraud Hotline.
3 Easy Steps to Help you Decide
Whether You Should Report Medicaid Fraud
If you have information regarding Medicaid Fraud in the State of Massachusetts, 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