Tennessee False Claims Attorney Explores Medicaid Fraud Reporting by Whistleblowers

Tennessee false claims act

Tennessee, 28 other states and the federal government are expected to receive $4.1 million as a result of the actions of a Medicaid fraud whistleblower. Earlier in September 2015, a whistleblower and his Tennessee false claim attorney fought another Medicaid fraud forcing Louisville-based PharMerica Healthcare to pay $1.3 million. It was accused of billing TennCare for more drugs than used. In one of the largest Medicaid fraud recovery, Florida-based Adventist Health System, which also has clinics in Tennessee, settled a 2012 whistleblower Medicaid fraud lawsuit for $118.7 million. Last year, home healthcare agency CareAll made a similar settlement for $25 million after a healthcare false claim lawsuit filed by a whistleblower and his Tennessee false claims attorney.

How To Report Medicaid Fraud?

The Tennessee Medicaid False Claims Act of 1993 allows anyone, a resident of the state or not, to report a Medicaid or healthcare fraud. However, he or she must have ample evidence to showcase embezzlement of funds and claims should not be more than three-year old.

A Medicaid fraud whistleblower should hire a false claims attorney in Tennessee to prepare and file a lawsuit. First, the claim is presented to the court or appropriate authorities “under seal.” The whistleblower may be interviewed by officials empowered to investigate Medicaid fraud and take a decision on joining the lawsuit. The relator is free to continue his or her Tennessee false claim lawsuit even if the state or federal authorities do not back the claim.

What is qui tam lawsuit?

A qui tam lawsuit is the paperwork filed in the court by whistleblowers. A civil lawsuit of this type has been instrumental in recovering more than $16 billion Medicaid funds embezzled through false billing practices. It allows a private individual to sue an entity, individual or business on the behalf of government for Medicaid fraud. The plaintiff’s identity and lawsuit details are kept secret until an investigation by authorities into the genuineness of the claim.  If there is a recovery, the “relator” will share in the recovery.

What a whistleblower can report?

  • Any false claim, action or practice leading to Medicaid fraud
  • False claims for Medicaid fund payments
  • Medicaid billing upcoding
  • Falsifying Medicaid record to seek a higher payment
  • Conspiracy to defraud Medicaid money
  • Avoiding payment of Medicaid-related amount to the state
  • Acting in an ignorant manner despite being aware of false payments
  • Deliberate ignorance of the false Medicaid payment
  • Any fraudulent act by individual, entity, trust, business or agency that cause Medicaid fraud

What type of benefits and protection a whistleblower is granted in Tennessee?

A Tennessee Medicaid fraud whistleblower is provided with several incentives and protective measures as a mean of encouragement. There are legal provisions to ensure safety of whistleblowers from ant retaliation, backlash, harm or loss of job.

The financial award for a whistleblower and his Tennessee false claims attorney amounts to 15 to 25 percent of total money recovered, including fines, when state or federal authorities joins the claim. Fighting on your own leads to a higher award, usually between one-third and one-fourth of the recovery. The plaintiff may also claim reimbursement of attorney fees and legal costs.

For free whistleblower case evaluation, please call on 1-800-632-1404 to consult our Medicaid false claims attorney in Tennessee.

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