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Florida Whistleblower Lawyers > Florida Waiving Co-Pay Lawyer

Florida Waiving Co-Pay Lawyer

The federal Medicare program covers a wide range of health care coverage for eligible recipients in Florida, who are required to contribute a nominal co-pay as patient cost-sharing for these services. Health care providers are required to collect these amounts and report them when seeking reimbursement, but some practitioners sidestep their obligations for financial gain. Routine waiving of co-pays is unlawful because of the impact upon taxpayers: The Centers for Medicaid & Medicare Services (CMS) reports that around $30 billion is diverted from Medicare every year due to such misconduct.

Lawmakers enacted the Federal False Claims Act (FCA) during the civil war to encourage individuals to expose fraud against the government. The law is just as important today for combatting co-pay waivers, and you may be entitled to compensation for your efforts in uncovering illegal practices. To learn more, please contact Guttman, Freidin & Celler today. You can schedule a free case review with a Florida Medicare fraud attorney, but an overview on waiving co-pays may be useful.

Co-Pay Waivers and Medicare Fraud

Though it can give rise to both criminal and civil liability, fraud in its basic form is using deception to gain a financial edge or some other item of value. Waiving co-pays may amount to Medicare fraud because a physician or practice is presenting false information to support a claim for reimbursement.

Note that isolated incidents of not collecting a co-pay may be entirely legal; it is only when co-pay waivers are a common practice that there may be a finding of fraud. Besides billing and not taking the co-pay amount, additional schemes include:

  • Improper recordkeeping on co-pays, i.e., writing them off;
  • Applying discounts to only the co-pay amount for products and services;
  • Establishing a bogus patient assistance fund for co-pays;
  • Accepting financial hardship excuses for co-pay waivers without investigating the patient’s situation.

Whistleblowers and Remedies Under FCA

The federal law provides for a cause of action known as qui tam, where an individual with information on fraud can sue the medical practice or physician for waiving co-pays. You may qualify as a qui tam plaintiff, known as a relator, to seek remedies and recover losses on behalf of CMS. As compensation for your efforts, you may be entitled to a share of the amount obtained from the defendant – which could be up to three times the damages suffered by CMS, on a per count basis. Your Medicare fraud attorney can explain the details, but compensation is calculated as:

  • 15 to 25 percent of the amount recovered if the government exercises its right to intervene after you file your FCA case;
  • Up to 30 percent if officials do not join in the lawsuit.

Our South Florida Medicare Fraud Lawyers Can Assist with Your Options

If you have knowledge about an unlawful co-pay waiver scheme or other forms of Medicare fraud, please call Guttman, Freidin & Celler at 800.654.8281 or contact us online. We can set up a no-cost consultation at our Miami offices to assess your situation, explain your remedies as a whistleblower, and discuss next steps.

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