Is Your South Dakota Employer Or Medical Provider Submitting False Claims To Medicaid?
Each year, fraudsters in the health care industry pocket millions in South Dakota taxpayer dollars. Up to 10%, nearly $82 million, of South Dakota Medicaid funds are lost to false billing and other fraudulent health care schemes annually.
Illegal use of South Dakota Medicaid funds meant for over 115,000 needy individuals and families results in the loss of valuable health care resources and increases the cost of health care for all South Dakota residents.
South Dakota’s Medicaid Fraud Control Unit (MFCU) was established in 1984 as a division of the Office of the Attorney General. The role of the MFCU is to investigate reports of fraud, waste and abuse of South Dakota Medicaid funds and recover reimbursements for the State. In 2015, South Dakota’s MFCU recovered nearly $190,000 in stolen Medicaid funds and achieved 19 civil settlements and judgements. But government resources are limited.
The discovery of incidents of fraud is largely dependent on South Dakota’s physicians, nurses, bookkeepers, technicians, pharmacists and other health care professionals who have first-hand access to billing policies, practices, products and services rendered.
The federal False Claims Act offers large cash awards to individuals who are the first report an incidence of South Dakota Medicaid fraud. If you suspect your health care employer is submitting false or fraudulent claims to South Dakota Medicaid, you may be eligible for a large cash award.
Don’t hesitate to call. Only the first to report a violation is eligible to collect a whistleblower cash award. Secure your eligibility now by calling the Medicaid Fraud Hotline or filling out the online form and receive an immediate and confidential, no-obligation case evaluation.
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Reporting South Dakota Medicaid Fraud
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What Laws Govern Reporting South Dakota Medicaid Fraud?
The decision to report an employer for Medicaid fraud can be difficult. This is why the federal False Claims Act (FCA), 31 U.S.C. §§ 3729 - 3733, pays cash awards for information and provides protection from employer retaliation in response to reporting fraud. The federal FCA enables individuals to file “qui-tam” whistleblower lawsuits on behalf of the government against individuals or entities they suspect have submitted false claims to government health care programs. When a whistleblower’s information leads to a successful verdict or settlement, that whistleblower is entitled to between 10% and 30% the money recovered.
If the whistleblower’s employer retaliates against him or her for reporting the fraud, that whistleblower may sue for damages.
A number of actions may violate the federal FCA, including:
- Overbilling, Double-billing, Unbundling
- Offering pay or gifts in exchange for patient referrals
- Creating false documents or making false statements to obtain Medicaid funds
- Billing for medically unnecessary care
- Billing for services not provided
- Marketing pharmaceuticals, medical devices or equipment for uses not approved by the FDA
- Services provided by unqualified staff
No proof of intent to defraud South Dakota Medicaid is required. In order to violate the federal FCA, a person must simply have actual knowledge of the information and act in deliberate ignorance of the truth or falsity of that information or act in reckless disregard of the truth or falsity of the information.
Cash awards paid for blowing the whistle on fraud are significant. Individuals who violate the federal FCA are liable to the United States government for a civil penalty of between $10,781.40 and $21,562.80 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 get 10% to 30% of the total recovery resulting from the information they provide.
Learn if your information qualifies for a whistleblower cash award. Contact the Medicaid Fraud Hotline by phone or fill out the online form for an immediate, confidential case evaluation.
What Laws Protect Those Who Report South Dakota Medicaid Fraud?
When an employer, contractor or agent chooses to fire, demote, suspend, threaten, harass or discriminate against an employee because that employee decides to report South Dakota Medicaid fraud or participate in an investigation, that employee has the right to sue for damages.
Under the federal False Claims Act (FCA), 31 U.S.C. §§ 3729 - 3733, whistleblowers who experience workplace retaliation are entitled to remedies that will make the employee whole – putting them back in the position they were in before the retaliation occurred. Remedies may include:
- Job reinstatement with the same seniority status
- Two times the amount of pay lost because of the discrimination
- Interest on the amount of pay lost
- Compensation for any special damages, costs and reasonable attorneys' fees
Reporting your health care employer for Medicaid fraud may be daunting, but South Dakota Medicaid fraud puts patients at risk and raises health care costs for everyone.
If you suspect your employer of inappropriate billing, physician kickbacks, misrepresentation or other fraudulent activity that results in false claims submitted to South Dakota Medicaid, you may be entitled to a substantial cash award. Contact the Medicaid Fraud Hotline Today.
What Cash Awards Are Offered For Reporting South Dakota Medicaid Fraud?
Cash awards often range in the hundreds of thousands to millions of dollars range for whistleblowers who report health care fraud. This is because whistleblowers are paid 10% to 30% of the total recovery amount. In the health care profession, hundreds or thousands of false claims may be submitted before fraud is detected.
Since penalties fall between $10,781.40 and $21,562.80 for each false claim, plus three times the amount of damages sustained by the government and the costs of any civil action, total government recovery can fall in the millions to billions of dollars.
Actual whistleblower award amounts are determined based upon a number of criteria, including:
- Whether or not the government chooses to intervene
- Significance of the whistleblower’s information
- Extent to which the whistleblower aids in the investigation
- Extent to which the whistleblower participated in the fraudulent act
In addition to the 10% to 30% of total government recovery, the court also awards the successful whistleblower with reasonable costs, attorney fees and reasonable fees for consultants and expert witnesses.
The government realizes the vital role whistleblowers play in putting a stop to South Dakota Medicaid fraud and offers substantial cash rewards for their valuable information. If you suspect Medicaid fraud is occurring within a South Dakota health care facility, you may be entitled to a significant cash award. Call today for a free, immediate and confidential case evaluation.
Are There Time Limits On Reporting South Dakota Medicaid Fraud?
Yes. A whistleblower must be the first to report their information to be eligible for the cash award. If others in your workplace have access to the same information and report that knowledge before you, you lose your eligibility to file a claim.
In addition, under the federal False Claims Act (FCA), 31 U.S.C. §§ 3729 - 3733, a whistleblower lawsuit must be brought within 6 years after the date of the violation or within 3 years after the date when facts material to the violation are known or reasonably should have been known.
In filing a claim for damages suffered as a result of employer retaliation, a civil action must be brought within 3 years of the date the retaliation occurred.
Don’t wait to make your report. In 2014, American whistleblowers collected over $435 million in for assisting in the recovery of $3 billion in stolen taxpayer dollars. Successful recovery of stolen South Dakota Medicaid funds is dependent on honest health care professionals coming forward to report their information. Learn your rights and secure your role as whistleblower. Call the Medicaid Fraud Hotline Now.
2 Easy Steps to Help you Decide
Whether You Should Report Medicaid Fraud
Whistleblowers Paid Over $1 Million Cash for Tips Leading to South Dakota Recovery