Medicare Overpayments Fraud Attorneys

For years, courts have held that it is a violation of the False Claims Act (FCA) when a provider has concealed or improperly avoided or decreased its obligation to pay the government, by failing to disclose and refund clear overpayments.

Liability is founded on the basis that the provider has an obligation to notify Medicare, of the overpayment, in its annual cost reports or otherwise.

With the enactment of the Patient Protection and Affordable Care Act of 2010, 42 U.S.C. § 1320a-7k(d), federal law explicitly provides for liability of providers when overpayments are retained.  For purposes of subsection 1320a-7k(d), “overpayments” are defined as “Medicare funds received or retained to which a person is not entitled, after applicable reconciliation.” Such overpayments must be reported and returned by the later of sixty days after they were identified or the date any applicable cost report is due. Any overpayment retained after this deadline is defined as an “obligation” within the meaning of the FCA.

This section of the Act, entitled “Reporting and Returning of Overpayments,” requires a person who has received an overpayment to report and return the overpayment to HHS, the State, an intermediary, a carrier, or a contractor, as appropriate, and to notify the HHS, State, intermediary, carrier, or contractor to whom the overpayment was returned in writing of the reason for the overpayment.

Examples of “overpayments” are:

    • Medicare payments for noncovered services.
    • Medicare payments in excess of the allowable amount for an identified covered service.
    • Errors and nonreimbursable expenditures in cost reports.
    • Duplicate payments.
    • Receipt of Medicare payment when another payor had the primary responsibility for payment.

Examples of overpayments also include:

  • A provider or supplier reviews billing or payment records and learns that it incorrectly coded certain services, resulting in increased reimbursement.
  • A provider or supplier learns that a patient death occurred prior to the service date on a claim that has been submitted for payment.
  • A provider or supplier learns that services were provided by an unlicensed or excluded individual on its behalf.
  • A provider or supplier performs an internal audit and discovers that overpayments exist.
  • A cost report provider receives an overpayment and fails to refund to Medicare after the applicable reconciliation takes place.

Whistleblower lawsuits based on hospital system retention of overpayments can be complex. Contact our whistleblower lawyers for more information.

REAL PEOPLE making real change Meet Some of our Heroes

Kathleen Hawkins

Dignity Health
$37 million

Kathleen Hawkins, RN MSN, had been employed by Defendant, Catholic Healthcare West (CHW) for approximately 6 years when she decided she had had enough of trying to change the hospital system from within.

CHW, a California not-for-profit corporation that operated hospitals in California, Arizona, and Nevada, was at the time the eighth largest hospital system in the nation and the largest not-for-profit hospital provider in California.

READ MORE

Joe Strom

Johnson & Johnson
$184 Million

Joe Strom contacted us in 2005. We were very grateful that he did. We immediately formed an all-star legal team and a process to stop a very harmful pharmaceutical marketing strategy. It was this process we set into motion that ultimately returned hundreds of millions of dollars to the U.S. Treasury, and a portion of that, very well-deserved, into Joe’s bank account.

Joe told us a very troubling story about the off-label promotion of a pharmaceutical drug for patients who already suffered from chronic heart failure.

READ MORE

Bruce A. Moilan Sr.

$27 Million

Bruce Moilan was a seasoned hospital systems expert by the time he contacted our Firm. At the time he decided to file his qui tam lawsuit, he was employed by South Texas Health System as a System Director for Materials Management. In this position, he oversaw $24 million in annual purchases of supplies and equipment and helped determine budget, reduction and cost analysis throughout the contract bidding and negotiations process. His job was to insure proper implementation for purchasing, receiving and management of inventory, for McAllen Hospitals, L.P.

READ MORE

Description
Description
Description

"I collaborated with Nolan, Auerbach and White on a broad variety of cases where whistleblowers stepped forward to disclose tactics employed by large companies to influence physicians' medical decision-making in patient care. They provide ample resources to not only optimize their client cases, but in doing so consistently leverage best medical evidence to further patient safety and resource utilization.”

— Fred Polsky M.D.,, Former Medical Director, CMS Zone 7 Integrity Contractor

Any Questions?

Am I potential whistleblower that matches up well with our firm?

We only want to represent amazing people.

How much will I make?

We cannot guarantee anything, but we will deliver on this promise: we will give you feedback and a prognosis within 48 hours of your submission of all details to us. We are the first healthcare fraud qui tam law firm, and have been doing only healthcare fraud whistleblower lawsuits for decades-so you can expect as accurate a picture as is possible.

Are my communications with you confidential?

They are 100% confidential. If we do not take your case, your information becomes inaccessible. We have no interest in it. Besides, it is protected by the attorney-client privilege under our lawyer regulations, and we would lose our license if we were to disclose one iota of information about you or your potential case.

    Contact Us

    Contact Us

    The more detailed the response, the more likely it is that we will be able to evaluate and determine if your potential False Claims Act case falls within our case requirements. IF IT DOES, WE WILL RESPOND TO YOU WITHIN 24 HOURS. (Names of potential defendants are not necessary at this point, should you feel more comfortable omitting them.) By law, all communications to us are 100% confidential.

    No. of Employees at the Company?
    Please read the following statement and then click "Send Form":

    Any response to your e-mail will be solely to communicate about our possible representation of you under the qui tam provisions of the False Claims Act. All e-mails submitted to us, whether we take your case or not, are 100% confidential. If we do not respond to your e-mail, then you have communicated information which we cannot address because it appears to fall outside of the False Claims Act or our case requirements.