Medicaid fraud case leads to conviction of Athens, Georgia therapist
Experts estimate that Medicare fraud costs the nation $60 billion annually despite tough whistleblower laws. They also predict that this number will continue to grow.
The story in Georgia is no different. In one recent Georgia case, an Athens psychologist was convicted after swindling Medicaid out of more than $550,000. The Atlanta Journal Constitution has the story.
One reason for the tremendous amount of fraud, and why it keeps growing, is that there are simply too many businesses and individuals who cheat the government for law enforcement to handle. In response, Congress and various states, including Georgia, passed powerful whistle blower laws which allow an individual to bring suit against a company that files a false claim with the government. While anyone may bring such a suit, employees are often in the best position to disclose the fraud.
In order to bring a successful qui tam action, an employee must have independent and direct knowledge of the government being defrauded by their employer. The whistleblower employee is typically entitled to 15 to 30 percent of the money recovered. In qui tam actions involving large businesses, it is not uncommon for the employee bringing the suit to recover millions of dollars.
It is important to understand that fraud can come in many forms. Some employers defraud the government by over billing for services or goods, billing for services or goods that never existed, or by producing inferior goods. In the health care setting, a health provider may also defraud the government by prescribing unnecessary prescriptions and procedures or even by stealing someone else’s identifying information and claiming that person as a patient for Medicare purposes.
In the recent Athens case, the convicted psychologist submitted thousands of claims for therapy work he never performed for real patients as well as for people that he never treated. Although this case was investigated by the Georgia Attorney General's office and federal officials, a whistleblower complaint could have been brought if timely filed by an employee or other insider with knowledge of the fraud.
Our whistle blower attorneys are able to help individuals report their employers for filing false claims with the government. Many times employees are hesitant to blow the whistle due to fear of reprisal by their employer. However, federal law protects whistle blowers against retaliation for investigating or prosecuting a potential qui tam claim.
