Under both the Medicare and Medicaid programs, when healthcare providers submit bills to government healthcare programs the forms they are required to submit to get paid include a number of certifications, including that the procedures, tests and devices were medically necessary, were actually used or performed, and were performed and used in compliance with all applicable rules and regulations. Further, pharmaceutical companies and pharmacy benefits managers that provide drugs, biologicals (vaccines) or services pursuant to the government paid programs are also required to certify that they are complying with all the terms set forth with their contracts with the government. One common type of fraud has been to falsify these certifications in order to get a health care claim paid or to obtain additional business. This again causes the government to pay more than required based on a fraudulent billing practice and can violate the False Claims Act.
If you believe someone has knowingly committed Medicare or Medicaid fraud and you would like to learn more about or bring a Medicare or Medicaid 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.