Do You Suspect Your Texas Employer Is Submitting False Claims to Medicaid?
Texas Medicaid is a federal/state cost-sharing program that provides quality health care to more than 4.1 million low-income, disabled and elderly Texas residents. When professionals and businesses in the health care industry take advantage of Texas Medicaid funds and submit false or fraudulent claims to gain a financial profit, Texas residents suffer and health care costs skyrocket.
Each year, Medicaid Fraud transfers billions of taxpayer dollars into the pockets of fraudsters. In 2015, the Texas Medicaid Fraud Control Unit prosecuted 85 criminal convictions and 10 civil judgements and settlements, recovering over $210 million in stolen Medicaid funds for the State of Texas. Medicaid providers like doctors, medical equipment companies, dentists, counselors, hospitals, nursing homes, clinics, pharmacies, ambulance companies and others are in the unique and powerful position to put a stop to Texas Medicaid Fraud.
Do you suspect your employer is participating in a scheme to profit financially from Texas Medicaid? Federal and state laws provide whistleblowers with powerful protection and large cash rewards for reporting information. You may be eligible for a significant cash award. Contact the Medicaid Fraud Hotline today for a free, immediate case evaluation to determine your eligibility to file a claim.
Review the Various Types of Medicaid Fraud
Reporting Texas Medicaid Fraud
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What Texas Laws Give Legal Rights to Medicaid Fraud Reporters?
The Texas Medicaid Fraud Prevention Act (TMFPA), Tex. Hum. Res. Code Ann. §§ 36.001 et seq., allows private citizens with knowledge of Texas Medicaid Fraud to file a claim on behalf of the State and collect a share of any government recovery.
Under the TMFPA, a person commits an unlawful act if the person:
- knowingly makes or causes to be made a false statement or misrepresentation of a material fact to receive a benefit or payment under the Medicaid program;
- knowingly conceals or fails to disclose information that permits a person to receive a benefit or payment under the Medicaid program;
- knowingly applies for and receives a benefit or payment on behalf of another person under the Medicaid program and converts any part of the benefit or payment to a use other than for the benefit of the person on whose behalf it was received;
- knowingly makes, causes to be made, induces, or seeks to induce the making of a false statement or misrepresentation of material fact concerning the conditions or operation of a facility in order that the facility may qualify for certification or recertification required by the Medicaid program;
- knowingly pays, charges, solicits, accepts, or receives a gift, money, a donation, or other consideration as a condition to the provision of a service or product or the continued provision of a service or product if the cost of the service or product is paid for, in whole or in part, under the Medicaid program;
- knowingly presents or causes to be presented a claim for payment under the Medicaid program for a product provided or a service rendered by a person who is not licensed to provide the product or render the service;
- knowingly makes or causes to be made a claim under the Medicaid program for a service or product that has not been approved or acquiesced in by a treating physician or health care practitioner, a service or product that is substantially inadequate or inappropriate or a product that has been adulterated, debased or mislabeled;
- knowingly fails to indicate the type of license and the identification number of the licensed health care provider who actually provided the service on a claim;
- conspires to commit a violation of the TMFPA’
- knowingly obstructs an investigation by the attorney general of an alleged unlawful act; or
- knowingly makes, uses, or causes the making or use of a false record or statement material to an obligation to pay or transmit money or property to this state, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to this state under the Medicaid program.
A person acts "knowingly" with respect to information if the person:
- has knowledge of the information;
- acts with conscious indifference to the truth or falsity of the information; or
- acts in reckless disregard of the truth or falsity of the information.
Proof of the person's specific intent to commit an unlawful act under the TMFPA is not required in a civil or administrative proceeding to show that a person acted "knowingly."
A person who commits an unlawful act under the TMFPA is liable to the State for the amount of any payment or benefit provided under the Medicaid program as a result of the unlawful act, interest on the amount of the payment or benefit, a civil penalty of between $5,500 and $11,000 for each unlawful act plus two times the amount of the payment or benefit.
Whistleblowers have legal rights and protections and significant cash rewards are paid for information leading to government recovery. Call the Medicaid Fraud Hotline now and discover your options for filing successful whistleblower claim.
Are Texas Whistleblowers Protected From Employer Retaliation After Reporting Medicaid Fraud?
Under the Texas Medicaid Fraud Prevention Act (TMFPA), Tex. Hum. Res. Code Ann. §§ 36.001 et seq., an employee, contractor, or agent, who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment because of a lawful act taken in furtherance of an action or other efforts taken by the person to stop one or more violations of the TMFPA is entitled to:
- reinstatement with the same seniority status the person would have had but for the discrimination
- not less than two times the amount of back pay
- interest on the back pay
- compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorney's fees.
Under the Texas Whistleblower Act, Tex. Gov’t Code §§ 554.001 et seq., a state or local governmental entity may not suspend, terminate or take other adverse personnel action against a public employee who in good faith reports a violation of law by the employing governmental entity or another public employee to an appropriate authority.
A public employee whose employment is suspended, terminated or subjected to an adverse personnel action in violation of the Texas Whistleblower Act is entitled to sue for:
- injunctive relief
- reinstatement to the employee's former position or an equivalent position
- compensation for wages lost during the period of suspension or termination
- reinstatement of fringe benefits and seniority rights lost because of the suspension or termination
- actual damages
- court costs and reasonable attorney fees
Timing is Critical! If you have been fired, demoted or otherwise harassed by your employer for speaking out regarding Texas Medicaid Fraud, contact the Medicaid Fraud Hotline immediately and find out how to proceed with your case.
What Cash Awards Are Paid for Reporting Texas Medicaid Fraud?
Under the Texas Medicaid Fraud Prevention Act (TMFPA), Tex. Hum. Res. Code Ann. §§ 36.001 et seq., if the Texas Attorney General opts to intervene in the lawsuit, whistleblowers are eligible to collect between 15-25 percent of the state’s total recovery. If the Attorney General declines to join the action, the whistleblower may proceed with a private legal team and stands to receive between 25-30 percent of the state’s total recovery.
Whistleblowers are also entitled to receive an amount for reasonable expenses, reasonable attorneys’ fees, and costs that the court finds to have been necessarily incurred.
Are There Time Limitations on Reporting Texas Medicaid Fraud?
Under the Texas Medicaid Fraud Prevention Act (TMFPA), Tex. Hum. Res. Code Ann. §§ 36.001 et seq., an action must be brought:
- Within 6 years of the alleged false claim OR,
- Within 3 years after the date when the facts material to the case should have been known, BUT
- Within a maximum of 10 years of the alleged false claim – whichever occurs last.
Under the Texas Whistleblower Act, Tex. Gov’t Code §§ 554.001 et seq., a public employee who seeks relief must file a claim within 90 days of the date on which the alleged retaliation occurred or was discovered by the employee through reasonable diligence.
3 Easy Steps to Help you Decide
Whether You Should Report Medicaid Fraud
If you have information regarding Texas Medicaid Fraud, contact the Medicaid Fraud Hotline or fill out the online report form.
Government Awards Over $1 Million for Information on Medicaid Fraud