Medicare fraud is a huge illegal business that costs all of us. In fact, scamming Medicare has become so lucrative that Nigerian and Russian mobsters have gotten involved. One New York crime “family” moved to Florida, because Medicare fraud is safer than traditional criminal activities, and much more lucrative, according to Forbes magazine.
How much Medicare fraud exists? No one really knows.
How much has been stolen? Countless billions.
Often, Medicare fraud is only caught when a brave employee is willing to come forward and act as a whistleblower. Do you suspect fraud where you work? Could you be a whistleblower?
Medicare Fraud in South Carolina
South Carolina Medicare fraud is prosecuted under the national False Claims Act, otherwise known as the Whistleblower Act, Qui Tam Statute or Lincoln Law. It gives the everyday citizen the power to bring legal action on the government’s behalf against those who have defrauded the government. In a successful qui tam suit, whistleblowers may collect from 15 to 30 percent of the money recovered.
Unfortunately, a lot of Medicare fraud has occurred in our state and in our nation. Here are just a few recent cases:
- In 2015, a California man was sent to prison for Medicare fraud. He established a “ghost” medical clinic in South Carolina that billed Medicare over $1.1 million. Medicare paid roughly $350,000 in claims.
- Also in 2015, qui tam suits alleging Medicare fraud that were filed by former employees of Nason Medical in Charleston were settled with the federal government for over one million dollars.
- One more this year: Two labs (VA and CA) that tested for heart disease settled for $48.5 million due to three whistleblower actions. Admirably, a Hilton Head doctor was one of the whistleblowers.
Medicare Advantage plans have come under fire as well. Allegations have been made against Blue Cross Blue Shield of South Carolina that they acted to cover up and hide fraudulent claims between 2006 and 2010. This same suit also named a Utah plan, formed by the Church of Jesus Christ of Latter-day Saints, which contracted with Blue Cross to process claims.
If You Step Forward
Some people fear they will experience retaliation if they blow the whistle on fraud. But you should be aware that there are a number of legal protections for whistleblowers. The rewards of putting a stop to wrongdoing are many, and the Louthian Law Firm will be at your side throughout the process to ensure that your legal rights are protected.