Is Your Ohio Health Care Employer Guilty of Medicaid Fraud?

Do You Have Knowledge of Ohio Medicaid Fraud?

Ohio Medicaid exists as a collaboration between the state and federal governments to provide quality health care services for low-income children, adults, elderly and disabled.

Analysts estimate that fraud and abuse account for up to 10% of all Medicaid expenditures annually, driving up the costs of healthcare for everyone and costing taxpayers billions per year.

In 2015, the Ohio Medicaid Fraud Control Unit (MFCU) investigated over 1,410 reports of fraud, waste and abuse, resulting in 160 criminal convictions and 17 civil settlements and judgements. That same year, the Ohio MFCU recovered over $18 million in stolen taxpayer dollars for the state. Government resources dedicated to discovering cases of Ohio Medicaid fraud are limited, but individuals working in the health care arena increase the impact of those resources substantially as they are in the position to gain inside information on Ohio Medicaid waste, fraud and abuse.

The federal False Claims Act provides whistleblowers with powerful protection and impressive financial incentives to come forward when they detect 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.

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Reporting Ohio Medicaid Fraud

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What Laws Apply to Reporting Ohio Medicaid Fraud?

The federal False Claims Act (FCA), 31 U.S.C. §§ 3729 - 3733, allows whistleblowers (“relators”) with knowledge of fraud against the government to file whistleblower actions on behalf of the government. The federal FCA protects whistleblowers from employer retaliation and offers significant cash awards for reporting fraud when actions lead to successful government recovery.

Successful whistleblower actions are brought each year against hospitals, nursing homes, ambulance companies, pharmacies and health care professionals who submit false claims to the government. Submission of a false claim can come in various forms, including:

• Overbilling Medicare, Medicaid, TRICARE or other government-funded health care program
• Upcoding or unbundling to overcharge the government
• Billing for goods or services not provided
• Making a false record or statement in order to receive payment on a claim
• Falsifying medical records or making false diagnoses
• Marketing pharmaceuticals for FDA-unapproved uses
• Making a false statement to avoid paying a debt to the government

The U.S. government fines individuals who violate the federal FCA with a civil penalty of between $5,000 and $10,000 per false claim, plus three times the amount of damages sustained by the government and the costs of any civil action brought to recover any such penalty or damages. Whistleblowers are awarded between 10% and 30% of the total government recovery in successful settlements or verdicts, with awards often falling in the hundreds of thousands to millions of dollars range.

Combatting Ohio Medicaid Fraud is a vital step in safeguarding our nation’s health care for future generations. Medicaid fraud harms everyone. If you suspect Medicaid Fraud is occurring in your Ohio place of business, you are protected by federal law and may be entitled to a substantial cash award for your information. Contact the Medicaid Fraud Hotline today and learn your options.

What Protection Does the Law Provide For Those Reporting Ohio Medicaid Fraud?

The federal False Claims Act (FCA), 31 U.S.C. §§ 3729 - 3733, has strong anti-retaliation provisions to protect individuals who try to stop fraudulent activity.Specifically, the federal FCA provides protection to individuals who are discharged, demoted, suspended, threatened, harassed, denied promotion or in any other manner discriminated against as a result of their disclosure of information or participation in an action relating to an FCA violation.

Individuals qualifying for protection against employer retaliation under the federal FCA may include those who:

• File a whistleblower claim against their employer or medical provider
• Intend to file a whistleblower claim against their employer or medical provider
• Aid a whistleblower in reporting fraud
• Reported fraudulent activity to a manager or supervisor in an attempt stop an FCA violation

Under the federal FCA, whistleblowers who experience workplace retaliation are entitled to all damages essential to “make the employee whole.” These remedies include:

• Position reinstatement with comparable seniority
• Two times the amount of any back pay lost through retaliation
• Interest on any back pay
• Reasonable attorneys’ fees and other litigation costs
• Compensation for other damages directly resulting from the retaliation

What Cash Awards Are Available for Reporting Ohio Medicaid Fraud?

Under the federal False Claims Act (FCA), 31 U.S.C. §§ 3729 - 3733, a whistleblower who is the first to file a complaint on an incident of fraud is entitled to between 10% and 30% of the total government recovery if the government prevails in the action:

• When the government choses to intervene, the whistleblower is entitled to between 10% and 25% of the proceeds of the action or settlement.
• When the government opts not to intervene, the whistleblower is entitled to between 25% and 30% of the proceeds of the action or settlement.

Whistleblowers also receive reasonable attorneys’ fees and an amount to cover the expenses and costs of bringing the action in successful government recovery cases. Final award amounts are based on the significance of the reported information and the extent to which the whistleblower aids in advancing the case to litigation.

The government’s ability to successfully prosecute cases under the federal False Claims Act is largely dependent on whistleblowers coming forward to report fraud. In 2014, approximately $3 billion dollars of the federal False Claims Act recoveries were the result of a whistleblower coming forward. That same year, American whistleblowers were awarded $435 million of the $3 billion dollars recovered by the federal government.

What is the Statute of Limitations on Reporting Ohio Medicaid Fraud?

The federal False Claims Act (FCA), 31 U.S.C. §§ 3729 - 3733, includes a six-year statute of limitations for bringing a whistleblower lawsuit. However, a three-year statute of limitations applies after the date when facts material to the right of action are known or reasonably should have been known.

A civil action under the anti-retaliation provisions of the federal FCA must be brought within 3 years of the date the retaliation occurred. Many variations may exist among the several states, making it imperative that Ohio Medicaid fraud whistleblowers contact the Medicaid Fraud Hotline to understand any time limitations on their case.

If you feel you have knowledge of Ohio Medicaid fraud, don’t let the opportunity to receive your whistleblower cash award slip away. Whistleblowers must be the first to report fraud to become eligible for the cash award. Contact the Medicaid Fraud Hotline today for a confidential, no-obligation case evaluation and solidify your role as whistleblower.

If you have information regarding Ohio Medicaid Fraud, contact the Medicaid Fraud Hotline or fill out the online report form. You must be the first to file a report to secure your role as whistleblower and be eligible for the cash award. Statutes of limitations apply. Contact the Medicaid Fraud Hotline to connect immediately for a no-cost, fully confidential case evaluation that will determine your options and eligibility to file a qui tam action.

Over $1 Million in Cash Awards for Tips Leading to Government Recovery