Do You Have Knowledge of Rhode Island Medicaid Fraud?
Rhode Island Medicaid provides health care services for less fortunate or disabled children, adults and elderly individuals who could not afford care otherwise. The state carefully distributes hard-earned Rhode Island tax dollars to ensure adequate funding of this valuable program. Many dishonest, corrupt health care industry professionals scheme to dodge Rhode Island Medicaid regulations in an effort to pocket taxpayer dollars for themselves. Every Rhode Island resident pays for the crime through the loss of indispensable government services and resulting tax increases.
In 2015 alone, the Rhode Island Medicaid Fraud Control Unit (MFCU) investigated over 42 reports of fraud, waste and abuse, resulted in 10 criminal convictions and 24 civil settlements and judgements, recovering over $535, 000 in stolen taxpayer dollars for the state of Rhode Island. These recoveries are largely due to the reports of whistleblowers – health care professionals who report knowledge of suspected fraud in their workplace.
Rhode Island physicians, nurses, pharmacists, EMTs, sales representatives and other health care professionals are in a prime position to identify and report fraud. Because the government relies on whistleblowers to detect and report cases of fraud, the Rhode Island False Claims Act awards whistleblowers with 10% to 30% of the total government recovery. 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 Rhode Island Medicaid Fraud
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What Rhode Island Laws Apply to Reporting Medicaid Fraud?
The Rhode Island False Claims Act (RIFCA), R.I. Gen. Laws §§9-1.1-1 et seq., allows individuals with knowledge of fraud against the state of Rhode Island to file a claim on behalf of the State. Whistleblowers who are able to provide information leading to successful government recovery are entitled to a share of the recovery and may file a claim for remedies if they experience employer retaliation in response to their involvement with the action.
Any person who commits the following acts violates the RIFCA:
- 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 RIFCA
- 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 property 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 an officer or employee of the state, or a member of the guard, who lawfully may not sell or pledge the property; or
- 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.
"Knowing" and "knowingly" means that a person with respect to information:
- Has actual knowledge of the information;
- Acts in deliberate ignorance of the truth or falsity of the information;
- Acts in reckless disregard of the truth or falsity of the information; and
- Requires no proof of specific intent to defraud.
Violations of the RIFCA are punishable by a civil penalty of between $5,500 and $ 11,000, plus three times the amount of damages the state sustains because of the act of that person. A person violating the RIFCA shall also be liable for the costs of a civil action brought to recover any such penalty or damages.
Federal and state False Claims Acts pay significant cash awards, often in the hundreds of thousands to millions of dollars, to those with information on Rhode Island Medicaid fraud that leads to a successful recovery. In addition, Rhode Island whistleblower laws give anti-retaliation protections to individuals who come forward and report misconduct. If you feel you have knowledge of Rhode Island Medicaid fraud, don’t hesitate to contact the Medicaid Fraud Hotline.
Does Rhode Island Law Provide Protection For Those Reporting Medicaid Fraud?
Under the Rhode Island False Claims Act (RIFCA), R.I. Gen. Laws §§9-1.1-1 et seq., any employee, contractor, agent, or associated others who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against because of lawful acts done by the employee, contractor, agent or associated others in furtherance of a RIFCA action is entitled to all relief necessary to make the employee, contractor, agent or associated others whole.
Such relief shall include:
- Job reinstatement with the same seniority status such employee, contractor, agent or associated others 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.
The Rhode Island Whistleblower’s Protection Act (WPA), R.I. Gen. Laws Ann. § 28-50 et seq., also protects whistleblowers from employer retaliation in response to reporting Rhode Island Medicaid fraud.
Under Rhode Island’s WPA, an employer may not discharge, threaten, or otherwise discriminate against an employee because:
- The employee, or a person acting on behalf of the employee, reports or is about to report a violation which the employee knows or reasonably believes has occurred or is about to occur, of a law or regulation or rule promulgated under the law of this state unless the employee knows or has reason to know that the report is false, or
- An employee is requested to participate in an investigation, hearing, or inquiry held by that public body, or a court action, or
- An employee refuses to violate or assist in violating federal, state or local law, rule or regulation, or
- The employee reports to the employer or to the employee's supervisor a violation, which the employee knows or reasonably believes has occurred or is about to occur, of a law or regulation or rule promulgated under the laws of this state, unless the employee knows or has reason to know that the report is false.
Under Rhode Island’s WPA, an employee may seek remedies including job reinstatement, the payment of back wages, full reinstatement of fringe benefits and seniority rights, actual damages, or any combination of these remedies. A court may also award the complainant all or a portion of the costs of litigation, including attorneys' fees if the court determines that the award is appropriate.
What Cash Awards Are Available for Reporting Rhode Island Medicaid Fraud?
Under the Rhode Island False Claims Act (RIFCA), R.I. Gen. Laws §§9-1.1-1 et seq., if the State proceeds with an action brought by a whistleblower, the whistleblower is entitled to between 15% and 25% of the proceeds of the action or settlement of the claim, depending upon the extent to which the person substantially contributed to the prosecution of the action.
If the state does not proceed with an action, the person bringing the action or settling the claim shall receive an amount between 25% and 30% of the proceeds of the action or settlement.
In both cases, the whistleblower is also entitled to receive an amount for reasonable expenses, plus reasonable attorneys' fees and costs.
Final award amounts are 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.
When Rhode Island Medicaid funds are wasted, stolen or abused, every Rhode Island resident pays the price. A whistleblower’s decision to report fraud directly influences the government’s ability to prosecute cases and stop Rhode Island Medicaid Fraud. Do you suspect your Rhode Island employer or other health care professional is defrauding Rhode Island Medicaid? Help put a stop to Medicaid fraud. Call now for a free, no-obligation case evaluation.
What is the Rhode Island Statute of Limitations on Reporting Medicaid Fraud?
Under the Rhode Island False Claims Act (RIFCA), R.I. Gen. Laws §§9-1.1-1 et seq., a civil action must be brought:
- Within 6 years of the date on which the violation is committed, or
- Within 3 years of the date when facts material to the right of action are known or reasonably should have been known by the official of the state charged with responsibility to act in the circumstances, but
- In no event more than 10 years of the date on which the violation is committed, whichever occurs last.
Under the anti-retaliation provision of the RIFCA, a civil action must be brought within 3 years of the date when the retaliation occurred.
A person who alleges employer retaliation under Rhode Island’s WPA must bring a civil action within 3 years of the occurrence of the alleged violation.
3 Easy Steps to Help you Decide
Whether You Should Report Medicaid Fraud
If you have information regarding Medicaid Fraud in the State of Rhode Island, 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. Help put a stop to Rhode Island Medicaid fraud. Call now for a free, no-obligation case evaluation.
Over $1 Million in Cash Awards for Tips Leading to Government Recovery