States Take False Claim Actions to Reduce Medicaid Fraud

States are mad as h#ll and are not going to take it anymore. The “it” in this cases is Big Pharma companies buddying up to pharmacies: paying kickbacks that encourage questionable Medicaid and Medicare billing.

Recently, the US government went after Novartis, seeking to reclaim about $3.3 billion in false claim allegations. Announcement of this claim sent a shock wave through the drug-making community. In 2014, the feds recovered $2.3 billion in False Claims Act settlements.

In the wake of that announcement, many states have been passing new false claims laws and expanding existing ones. Almost 30 states, reports the taxpayers Against Fraud Education Fund, are looking to pursue false claims actions against drug makers, suppliers and healthcare professionals and providers who have been overbilling state Medicaid programs. The lure of recovering funds bilked by nursing homes, physicians and other healthcare entities that have been falsely billing state Medicare and Medicaid coffers is rather attractive for states that are facing major budget deficits.

Any company or person who knowingly commits fraud against the government may be sued under stringent false claims laws. The US government’s False Claims Act recovers multi-billions of dollars of Medicare and Medicaid funds annually. Now states are stepping up their game, looking to encourage whistleblowers to uncover fraudulent activity. Similar to the federal law, many states are allowing individuals to initiate false claims actions against wrongdoers.

Under the federal False Claims Act, an individual (the whistleblower or relator) can bring a claim that uncovers fraud against the US government. The Feds can join the action bought by a private whistleblower or not. Either way, if the case is successful, the whistleblower is entitled to a share of the recovered money. Now states are encouraging the same rules for whistleblowers on a more local level.

If you have information that shines a line on fraudulent activity being committed against the government, either the federal government or on the state level, talk with a whistleblower lawyer who knows false claims law and who will protect your rights as you pursue your claim. Ross Begelman of Begelman & Orlow has been helping clients with whistleblower cases for many years. Contact him today about your claim.