Providing or Accepting Kickbacks for Referrals
Delivering quality medical care should always be the top priority for doctors, but some health care providers put profits above the needs of patients. To prevent these tactics, lawmakers enacted statutes making it unlawful to provide or accept kickbacks for referrals. Despite the threat of both criminal and civil penalties, far too many providers engage in Medicare fraud by violating these rules. The Centers for Medicaid & Medicare Services (CMS) has resolved hundreds of cases over the last decade, amounting to more than $36 million recovered due to providing or accepting kickbacks for referrals.
One of the most powerful tools in fighting Medicare fraud is the Federal False Claims Act (FCA), which incentivizes whistleblowers to come forward and expose misconduct. You could be rewarded for your efforts, and our team at Guttman, Freidin & Celler can explain how the legal process works. Please contact us to schedule a free case review with a Florida Medicare fraud attorney, and read on for an overview on providing or accepting kickbacks for referrals.
How Improper Referrals Defraud Medicare
The basic definition of fraud is using deception to gain an advantage; in the context of Medicare fraud, a person or entity deceives CMS by intentionally submitting false documentation for reimbursement. Through such a scheme, health care providers can receive payments that are not authorized or higher amounts than they should.
Taking the specific circumstances of kickbacks for referrals, the misconduct is Medicare fraud because the money or other item of value influences decision-making by health care providers. Instead of being motivated to deliver quality patient care, unscrupulous physicians prioritize financial gain. In doing so, they increase Medicare costs by ordering unnecessary services or prescriptions.
FCA Remedies for Whistleblowers
The FCA protects the government from all types of fraudulent schemes, including Medicare fraud, by creating a private right of action for a person with knowledge of the details. The legal remedy is called a qui tam lawsuit, which a plaintiff can file against the party that perpetrated the fraud. If the facts prove the providing or accepting of kickbacks for referrals, the defendant could be liable for three times the losses CMS sustained. FCA actions are extremely complex and the evidence is highly technical, so it is wise to retain a Medicare fraud attorney right away.
If you know of such a scheme, you could qualify to obtain a portion of these monetary damages for your efforts as a whistleblower. The nature of your compensation depends on whether government officials intervene in the qui tam lawsuit, but it could be up to 30 percent of the total recovery. Considering that the damages are three times the losses of CMS, the amount could range in the millions.
Set Up a Consultation with a South Florida Medicare Fraud Lawyer
If you have concerns about improper referrals or kickbacks, please contact Guttman, Freidin & Celler right away to discuss your legal options under the FCA. You can set up your free case assessment at our offices in Miami, FL by calling 800.654.8281 or visiting us online.