Is Your North Carolina Employer or other Medical Provider Guilty of Medicaid Fraud?
North Carolina Medicaid is a partnership between the State of North Carolina and the federal government that provides health care services to low-income individuals and families. It is estimated that fraud and abuse of funds meant for North Carolina Medicaid beneficiaries account for up to 10% of all Medicaid expenditures annually, driving up the costs of health care and costing taxpayers billions per year.
The North Carolina Attorney General's Medicaid Investigations Division (MID) investigates and prosecutes health care fraud committed by Medicaid providers who scheme to pocket hard-earned taxpayer dollars for themselves. The North Carolina MID prosecuted 18 criminal convictions and 20 civil settlements in 2015, recovering more than $23 million in cases of North Carolina Medicaid fraud and abuse.
Many of those cases were initiated by whistleblowers - professionals working in the health care arena who had inside knowledge of North Carolina Medicaid Fraud. North Carolina and federal law provides large cash awards and powerful protections to individuals who report knowledge of North Carolina Medicaid fraud. If you have information regarding Medicaid Fraud in the State of North Carolina, contact the Medicaid Fraud Hotline or fill out the online report form.
Review the Various Types of Medicaid Fraud
Reporting North Carolina Medicaid Fraud
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What North Carolina Laws Apply to Reporting Medicaid Fraud?
The North Carolina False Claims Act (NCFCA), N.C. Gen. Stat. §§1-605 et seq., enables private citizens who have knowledge of suspected fraud against the government to file a claim on behalf of the state and share in a percentage of any government recovery.
Any person who commits any of the following acts is in violation of the NCFCA:
- 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 the NCFCA.
- Has possession, custody, or control of property or money used or to be used by the State and knowingly delivers or causes to be delivered less than all of that money or property.
- Is authorized to make or deliver a document certifying receipt of property used or to be used by the State and, intending to defraud the State, 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 any officer or employee of the State who lawfully may not sell or pledge the property.
- Knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the State, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the State.
Any person who acts in violation of the NCFCA is liable for three times the amount of damages that the State sustains because of the act, plus costs of a civil action brought to recover any of those penalties or damages and a civil penalty of between $5,000 and $11,000 for each violation.
Government resources dedicated to fighting Medicaid fraud are limited, but physicians, nurses, pharmacists, sales representatives and other health care professionals can increase the effectiveness of those resources substantially. You are in the unique position to gain inside information on North Carolina Medicaid waste, fraud and abuse. 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.
Does North Carolina Law Provide Protection For Those Reporting Medicaid Fraud?
Whistleblower Protections under the North Carolina False Claims Act
Under the North Carolina False Claims Act (NCFCA), N.C. Gen. Stat. §§1-605 et seq., any employee, contractor, or agent who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against because of lawful acts done by the employee, contractor, or agent in furtherance of efforts to stop one or more violations of the NCFCA, including investigation for, initiation of, testimony for, or assistance in an action filed or to be filed under the NCFCA, may file a claim for all relief necessary to make the employee whole.
Such relief shall include:
- reinstatement with the same seniority status the employee would have had but for the discrimination
- two times the amount of back pay
- interest on the back pay, and
- compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys' fees.
Whistleblower Protections under North Carolina’s Whistleblower Protection Law
Under the North Carolina Whistleblower Protection Law, N.C. Gen. Stat. §§ 126-84 et seq., North Carolina State employees are encouraged to report verbally or in writing to their supervisor, department head, or other appropriate authority, evidence of activity by a State agency or State employee constituting:
- A violation of State or federal law, rule or regulation;
- Misappropriation of State resources;
- Substantial and specific danger to the public health and safety; or
- Gross mismanagement, a gross waste of monies, or gross abuse of authority.
Under the North Carolina Whistleblower Protection Law:
- No head of any State department, agency or institution or other State employee exercising supervisory authority shall discharge, threaten or otherwise discriminate against a State employee regarding the State employee's compensation, terms, conditions, location, or privileges of employment because the State employee, or a person acting on behalf of the employee, reports or is about to report, verbally or in writing, any activity described in G.S. 126-84, unless the State employee knows or has reason to believe that the report is inaccurate.
- No State employee shall retaliate against another State employee because the employee, or a person acting on behalf of the employee, reports or is about to report, verbally or in writing, any activity described in G.S. 126-84.
- No head of any State department, agency or institution or other State employee exercising supervisory authority shall discharge, threaten or otherwise discriminate against a State employee regarding the employee's compensation, terms, conditions, location or privileges of employment because the State employee has refused to carry out a directive which in fact constitutes a violation of State or federal law, rule or regulation or poses a substantial and specific danger to the public health and safety.
Under the North Carolina Whistleblower Protection Law, an employee may seek remedies including an injunction, damages, reinstatement of the employee, the payment of back wages, full reinstatement of fringe benefits and seniority rights, costs, reasonable attorney's fees or any combination of these.
What Cash Awards Are Available for Reporting North Carolina Medicaid Fraud?
Under the North Carolina False Claims Act (NCFCA), N.C. Gen. Stat. §§1-605 et seq., if the State proceeds with an action brought by a whistleblower, the whistleblower is entitled to receive between 15% and 25% of the proceeds of the action or settlement of the claim, depending upon the extent to which the whistleblower contributed to the prosecution of the action.
If the State does not proceed with an action, the whistleblower shall receive between 25% and 30% of the proceeds of the action or settlement of the claim. an amount which the court decides is reasonable for collecting the civil penalty and damages.
In both cases, the whistleblower also shall receive an amount for reasonable expenses that the court finds to have been necessarily incurred, plus reasonable attorneys' fees and costs.
Combatting North Carolina Medicaid Fraud is vital to safeguarding our nation’s health care funding for future generations. If you suspect Medicaid Fraud is occurring in your place of business, you are protected by federal and state law and may be entitled to a substantial case award for your information. Contact the Medicaid Fraud Hotline Now.
What is the North Carolina Statute of Limitations on Reporting Medicaid Fraud?
Under the North Carolina False Claims Act (NCFCA), N.C. Gen. Stat. §§1-605 et seq., a civil action must be brought:
- within six years after the date on which the violation was committed or
- within three years after the date when facts material to the right of action are known or reasonably should have been known by the official of the State of North Carolina
- but no longer than 10 years after the date on which the violation is committed, whichever occurs last.
Under the North Carolina Whistleblower Protection Law, N.C. Gen. Stat. §§ 126-84 et seq., any State employee injured by a violation may maintain an action for remedies against the person or agency who committed the violation within one year after the occurrence of the alleged violation.
3 Easy Steps to Help you Decide
Whether You Should Report Medicaid Fraud
In 2014, approximately $3 billion dollars of the total recoveries made through the Federal False Claims Act were the result of a whistleblower coming forward. The nation’s whistleblowers received $435 million of the $3 billion dollars recovered by the federal government as a result of their disclosures that year. Be a part of the solution. Time is of the essence as you must be the first to act to secure your role as whistleblower and be eligible for a cash award.
Over $1 Million in Cash Awards for Tips Leading to Government Recovery