Under the Medicare and Medicaid programs, health care providers typically are reimbursed based on a fixed amount for a specified diagnosis, regardless of the provider’s costs or how long the patient’s hospital stay.  Further, in certain cases where insurance companies provide supplemental Medicare insurance coverage, the hospital may be paid on a per patient basis, irrespective of the patient’s current state of health or medical history.  In both cases, providers and insurance companies can maximize their profits or reduce their costs by limiting the number of sick patients they have to treat to be reimbursed by the government programs or private insurance companies.  When a health care provider or insurance company discriminates against enrollment by patients that they recognize as posing higher costs because they are deemed to be sicker or pose a higher risk for illnesses, these discriminatory practices are commonly called “red-lining,” and can violate state and federal laws, which in turn may violate the False Claims Act.

If you believe someone is engaged in red-lining discriminatory practices and you would like to learn more about or would like to bring a whistleblower lawsuit, the qui tam lawyers at Keller Grover LLP can help you. These whistleblower lawyers understand qui tam litigation, including the whistleblower protection provisions, and strive to achieve the best possible results for their clients