Georgia Trial Lawyer Blog

Two years ago Medicare implemented a whistleblower hotline in Miramar, Florida with the sole purpose of cracking down on Medicare and Medicaid fraud. In May, the hotline lit up with Miami senior citizens claiming that their bills listed treatments that they never received.

The Miami Herald has the story.

The calls led to the arrest of Feliberto Ramos, the owner of Miracle Group Rehabilitation Center, for falsely billing Medicare for $3.1 million. In total, Medicare paid Ramos $1.9 million on rehabilitation claims that were never provided to patients. Ramos was ultimately convicted of fraud and received a three year sentence.

Until recently, only three people were manning the hotline which is run by company called SafeGuard. Now, the hotline has about 15 operators and 15 investigators to combat the multibillion dollar Medicare fraud problem in south Florida.

Most of the calls concern false billing. Approximately 15% are for services and goods that were never provided such as mental-health counseling, physical rehabilitation, wheelchairs and medical supplies. The most compelling calls are forwarded to the investigative team. Ultimately, the FBI and federal agents are alerted to the fraud, and in cases like Ramos, arrests are made.

The Medicare hotline is one more tool in the government’s war against Medicare fraud.

The greatest defense, however, is the millions of Americans who work in the health care industry. Our whistleblower attorneys can help health care employees report Medicare fraud and other fraudulent healthcare billing practices by filing what’s known as a qui tam lawsuit. A qui tam suit is a civil action that is filed on behalf of the U.S. government to recover the stolen funds. In many cases, a whistleblower can recover a significant amount of money when the government recovers from the fraudulent provider.

Federal qui tam lawsuits can be brought by knowledgeable whistleblowers who are aware of Medicare and other types of health care fraud. In bringing such claims, whistleblowers will be protected and can often recover substantial rewards when the government pursues the claim and prosecutes or sues the company or person committing the fraud.

Some cases can involve hundreds of millions of dollars. Recently, federal agents arrested 36 individuals accused of defrauding Medicare and Medicaid out of approximately $251 million. A total of 94 individuals have been indicted so far. The raids involved over 300 agents and occurred in cities in Florida, New York, Louisiana, Michigan and Texas.

The Atlanta Journal Constitution has the story.

In Miami alone, federal agents indicted 33 individuals who are accused of scamming the government out of $140 million. Other cities which authorities targeted were New York City, Houston, Baton Rouge and Detroit.

Federal prosecutors say the schemes which fraudsters are using are becoming more and more advanced. Simple fraud operations have now been replaced by complicated networks of patient recruiters, doctors and clinic owners.

Some of these cases may have started as whistleblower actions. Federal law allows individuals directly aware of billing fraud to bring a lawsuit on behalf of the government. These types of suits are known as qui tam actions. In a qui tam action, an individual whistleblower can expect to earn 15 to 30% of the money that is recovered. In many cases, this amount can exceed $1 million.

Our whistleblower lawyers can help employees blow the whistle on businesses that defraud Medicare and Medicaid by filing a qui tam suit. We are currently investigating several claims similar to the one discussed above, and we expect the government to pick up these cases and pursue recovery from the companies involved in the fraud. Because they were the first ones to disclose the fraud, our clients stand to recover substantial monetary rewards.

Whistleblower actions and qui tam litigation also help curtail government waste and save taxpayers from having to pay for false and fraudulent claims. That's a benefit we can all appreciate.

The White House announced last week that it will begin employing several new programs to cut down on fraud and abuse which have plagued the federal government. In particular, the new programs will target private contractors that receive funding from the President’s stimulus plan. The new initiatives are expected to help cut down on Medicare and Medicaid fraud as well. The increased attention may also have
a significant effect on the number of qui tam suits filed by whistleblowers.

CNN has the story.

The most anticipated initiative is the “do not pay” list. The list is expected to solve the federal government’s problem with keeping tabs on private contractors. In many cases, one federal agency will ban a private contractor for fraud or abuse while another federal agency will hire the same contractor. In other words, the right hand doesn’t know what the left hand is doing. The new “do not pay” list will be provided to all government agencies to ensure that banned contractors are not hired by any federal agency. Agencies have also been ordered to review all government databases before paying private contractors.

Officials are hopeful that the new programs will also aide in the fight against Medicare and Medicaid fraud. In 2009 alone, the government estimates that Medicare and Medicaid were swindled out of $65 billion. Medicare accounted for $47 billion of the fraud.

The White House is also developing ways to stop payments to dead people and convicted felons. In the past three years, the federal government paid 20,000 dead Americans an estimated $180 million. In addition, around 14,000 incarcerated felons also received federal funds.

The new programs are part of an overall framework in the government’s ongoing battle against fraud. The most powerful weapon, however, are the millions of employees who work for private contractors and healthcare companies that receive federal funds. These employees are the first to see the fraud and often the only ones with the power to stop it.

Under federal law, an employee or “whistleblower” that sees evidence of such fraud may bring a suit against their employer on behalf of the U.S. government. These law suits are known as “qui tam” actions. In many qui tam cases, it is not uncommon for whistleblowers to receive millions of dollars for simply stepping forward.

With the President bringing attention to the nation’s serious fraud problem, the number of qui tam suits filed by employees is expected to grow.

Our qui tam lawyers are able to help these whistleblowers file suit against corporations and businesses that defraud the government. While qui tam suits are often the only way to hold corrupt companies accountable, we recognize that many employees are hesitant to file suit against their own employer for fear of retaliation. It is important for whistleblowers to understand that federal law protects employees who bring a qui tam action from any type of retaliation.

Mohawk Industries, a Georgia business which makes carpet and flooring, recently agreed to settle a labor lawsuit for $18 million. The suit alleged RICO violations involving the regular hiring of illegal immigrants. The suit was brought by current and former employees who complained that the company’s hiring practices resulted in lower wages for employees lawfully in the country.

Lawyers in the case predict that similar RICO lawsuits will soon be filed in Georgia as well as in other states with high immigration rates.

The Atlanta Journal Constitution has the story.

What made the Mohawk lawsuit unique is how the suit was brought. The employees alleged violations under the Georgia and federal Racketeer Influenced and Corrupt Organization act which is commonly referred to as RICO. RICO was originally used by federal authorities to prosecute organized crime. Today, however, the use of RICO has expanded to labor lawsuits involving large corporations. This case expanded its use even further to include labor suits in which a corporation has hired illegal aliens.

Corporations involved in industries such as poultry processing, manufacturing, agriculture, carpet and flooring, and other industries which attract immigrants are expected to see the largest increase in similar RICO lawsuits. This may be especially true for businesses in Georgia, since many of the areas outside of metro-Atlanta are home to these types of industries.

To bring a RICO suit against a corporation in Georgia, a plaintiff generally needs to show that the corporation engaged in a pattern of unlawful conduct. In the Mohawk case, the pattern was the alleged consistent hiring of illegal immigrants. If successful, plaintiffs in a RICO lawsuit are entitled to three times the actual damages sustained. A plaintiff may also be entitled to punitive damages in order to punish and to deter the corporation from committing crimes in the future.

Our firm has successfully handled several RICO lawsuits in which a corporation repeatedly violated the law in order to maximize profits. In our experience, the filing of a RICO lawsuit is often the only way to hold such a corporation responsible for the harm that it has caused. In many cases, a RICO lawsuit will also prevent future abuses of employees and consumers.

A nurse at the Satilla Regional Medical Center in Waycross, Georgia filed a qui tam action against the hospital in 2007 for allegedly defrauding Medicare and Medicaid. Recently, the Department of Justice announced that it will be taking over the case.

Georgia Public Broadcasting has the story.

A qui tam law suit is when an individual sues a business for defrauding the government by filing a false claim. Qui tam law suits are most commonly filed in connection with health care fraud although virtually any type of company may be sued. To succeed in such a law suit, a whistle blower needs independent and direct knowledge that a business has defrauded the government. Whistleblowers are typically employees of the business being sued, since generally only employees are privy to such information.

If a qui tam suit is successful, a whistle blower can expect to be awarded 25 to 30 percent of the amount that is recovered. However, in some cases, the government will decide to take over the case. In those situations, a whistle blower can expect to earn 15 to 25 percent. It is not uncommon for whistle blowers to recover millions of dollars especially if the fraud was pervasive or if the law suit concerns a large corporation.

In the recent Waycross hospital case, the nurse filed suit after she saw a doctor puncture an artery of a patient during surgery and then abandon the patient. That patient later died. U.S. District Attorney Ed Tarver announced that his office was taking over the case after discovering that the hospital’s actions may have been profit-driven. According to Tarver, the hospital knew the doctor in question was not credentialed to conduct that type of surgery but allowed the doctor to do so anyway. The DOJ also believes that Medicaid and Medicare paid for treatments that were unnecessary.

Aside from unnecessary treatments, a qui tam action may be proper anytime an employer over charges, bills for something that never existed, produces inferior goods, or uses false or stolen identities in order to defraud the government out of money.

Our whistle blower lawyers are able to help employees and individuals file suit against companies that defraud the government. We understand that many employees are hesitant to speak out against their employer; however, it is important for employees to know that federal law protects whistle blowers from retaliation by their employers.

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.

Medicare covers more than 46 million Americans who are elderly or disabled and pays out nearly $500 billion annually. However, Medicare fraud costs taxpayers around $60 billion a year and has become what many have described as the most profitable crime in America.

60 Minutes ran a recent story on the issue.

Authorities admit that deceiving the government with false Medicare claims is quite easy. Typically, an offender will attain a list of Medicare patients with their names, social security numbers and birth dates. The offender will then open a phony store front that claims to be a pharmacy, clinic or medical supply store and simply bill Medicare for items and services that never existed.

Under the law, Medicare must pay the claim within 15 to 30 days. Since Medicare only has a few auditors, much of the fraud simply goes undetected. When inspectors are sent to investigate a suspicious claim, they generally do so after the checks have been delivered. By that time, the phony business has usually been abandoned and the offender has moved onto a new phony business. FBI agents say that it’s not unusual for a single fraudster to make $400,000 or more a month.

However, Medicare fraud is not limited to the common fraudster. Doctors have been convicted of Medicare fraud for billing unnecessary prescriptions and procedures. And hospitals have been accused of taking in homeless patients to fill empty beds. Government officials fear the problem will only grow worse as people create new ways to take advantage of the system.

Yet, taxpayers are empowered to stop Medicare fraud through whistleblower laws. Any person who has direct and independent knowledge of Medicare fraud may bring a civil suit on behalf of the government. This is known as a qui tam action. Under federal law, those committing the fraud are liable for each act of fraud between $5,000 and $10,000 and three times the amount of damage that the government sustained. The person who brings the suit is generally entitled to 15 to 30 percent of the amount recovered.

Our whistleblower attorneys have helped several people blow the whistle on government billing fraud and false claims. It is important to understand that Medicare fraud can occur in many different ways including billing for non-existent patients, services that were never performed, giving false information or false certification, kickbacks, upcoding schemes and lack of medical necessity. By blowing the whistle on these practices, a person can help the government put an end to the fraud and attain significant monetary damages.

Pate & Brody is an accomplished Georgia law firm with offices in Atlanta, Macon and Madison. Our lawyers are dedicated to pursuing justice for crime victims, people who have been defrauded by deceptive business practices, or injured through the fault of others. Our lawyers have been recognized on the list of Georgia's "Super Lawyers", and included among Georgia's "Legal Elite" by Georgia Trend Magazine.

A federal racketeering suit has been filed against Toyota for concealing and destroying evidence in hundreds of rollover cases in what has been called a “ruthless conspiracy.” Perhaps most shocking is that the person bringing suit is the former managing counsel for Toyota Motor Sales.

CBS News has the story.

As an attorney for Toyota, Dimitrios Biller defended rollover lawsuits from 2003 to 2007 which involved instability and weak roofs in Toyota’s SUVs and pickups. Biller claims he consistently complained to supervisors about Toyota’s legal misconduct in those cases, and that he was ultimately pushed out the door for voicing his objections.

Biller filed suit in July in federal court in Los Angeles. In the suit, he claims that the motor company withheld evidence of its vehicles’ structural shortcomings. Specifically, he states that the company did not produce emails and electronic information to plaintiffs as is required by law. The lawsuit alleges that in one case a court ordered Toyota to disclose electronic data but that Toyota defied the order. Biller claims he attempted to save the information which included design and test data; however, Toyota destroyed the documents. The destroyed information should have been sent to plaintiffs in over 300 rollover cases.

The suit further alleges that Toyota withheld testing records of its vehicles’ roofs. For instance, Biller claims Toyota failed to produce documents which showed that its internal standard for roof strength was more durable than is required by federal regulations.

Toyota counters that the allegations are “inaccurate and misleading.” It further argues that Biller has violated his ethical obligations to Toyota by violating the attorney-client privilege. A hearing has been set for September 14 to determine if the complaint should be sealed due to privileged and confidential information.

The charges in Biller’s suit are echoed by many product liability lawyers who have dealt with Toyota in the past. If the charges prove to be true, it is possible that hundreds of seriously injured or killed plaintiffs were denied justice.

Pate & Brody is an accomplished Georgia law firm with offices in Atlanta, Macon and Madison. Our lawyers are dedicated to pursuing justice for crime victims, people who have been defrauded by deceptive business practices, or injured through the fault of others. Our lawyers have been recognized on the list of Georgia's "Super Lawyers", and included among Georgia's "Legal Elite" by Georgia Trend Magazine.

A federal jury awarded a former nursing student of Appalachian Technical College $450,000 for wrongful expulsion.

The Atlanta Journal Constitution has the story.

Sara Castle, 55, was 13 weeks away from graduating from ATC when the school expelled her. Castle complained that she was kicked out for exposing a professor who would dismiss students from class early.

To obtain the degree Castle was studying for, she and her classmates needed 740 hours of training. She argued that the professor’s practices made that 740 hour mark impossible to reach, and as a result, students were not receiving the training they needed to become competent nurses. Upon exposing the professor, Castle alleged that ATC fired the professor and expelled Castle.

The jury deliberated for less than an hour before siding with Castle. The college was represented by the Georgia Attorney General’s Office which is now contemplating challenging the verdict.

The ordeal for Castle has been an emotionally charged journey after dealing with the humiliation of being expelled. She has also had to come to terms with the fact that she will never attain her dream of becoming a nurse.

Pate & Brody is an accomplished Georgia law firm with offices in Atlanta, Macon and Madison. Our lawyers are dedicated to pursuing justice for crime victims, people who have been defrauded by deceptive business practices, or injured through the fault of others. Our lawyers have been recognized on the list of Georgia's "Super Lawyers", and included among Georgia's "Legal Elite" by Georgia Trend Magazine.

Four former employees of American InterContinental University have filed a whistle blower lawsuit against the university on behalf of the federal government. The employees allege fraud that could total more than $100 million in grant money.

The Atlanta Journal Constitution has the story.

The four employees, who worked at AIU’s Dunwoody campus, claim that the university enrolled students who could not read and did not have high school diplomas. The lawsuit also alleges that the university gave recruiters bonuses based on the number of students they enrolled in violation of federal law.

In order for a college to receive certain types of aid, it must have accreditation from an organization recognized by the U.S. Department of Education. In this case, the Southern Association of Colleges and Schools (SACS) gives AIU its accreditation. SACS put AIU on probation in 2006 and 2007 for giving rewards to recruiters and for enrolling students who did not possess high school diplomas. The suit alleges that AIU attempted to deceive SACS prior to its 2007 visit by removing documents that mentioned enrollment quotas. In addition, the four employees claim that the quota system continued even after AIU had completed its probation.

The plaintiffs’ attorney Joseph Wargo believes that the fraud exceeds $100 million in grant money as well as a significant amount in federal loans. AIU has not commented on the allegations but says that it intends to fight the suit.

Pate & Brody is an accomplished Georgia law firm with offices in Atlanta, Macon and Madison. Our lawyers are dedicated to pursuing justice for crime victims, people who have been defrauded by deceptive business practices, or injured through the fault of others. Our lawyers have been recognized on the list of Georgia's "Super Lawyers", and included among Georgia's "Legal Elite" by Georgia Trend Magazine.

There are allegations that U.S. Senator Saxby Chambliss attempted to discredit a whistleblower at a Senate hearing last year, and that he did so at the urging of the company the whistleblower was trying to expose.

The Savannah Morning News has the story.

In February 2008, a fire at Imperial Sugar’s Port Wentworth refinery killed 14 people. The United States Senate held a hearing in July of that year which focused on the cause of the fire. At the hearing, the company’s former executive, Graham Graham, testified that the company prevented him from making refineries safer. During Graham’s statements, Senator Chambliss frequently interrupted and challenged Graham’s veracity on more than one occasion. Chambliss does not sit on the subcommittee which questioned Graham, but he was invited by the committee’s ranking Republican, Senator Johnny Isakson, to partake in the hearing.

Before the hearing, Imperial Sugar lobbyist George Baker sent a memo and five documents to Chambliss which detailed a phone conversation that had taken place the day before between Chambliss, the company’s CEO, and Baker. The memo stated that Imperial disagreed with what Graham was going to say at the hearing and provided Chambliss with questions to ask Graham during the hearing. Chambliss did in fact ask questions which were similar to those the company provided.

In addition, one of the documents sent to Chambliss was written by a former OSHA inspector. The document stated that OSHA never trained him on the hazards of combustible dust which is believed to be one reason for the fire, and that OSHA lacked clear standards on combustible dust. The inspector wrote and signed the document the same day as the Barker memo at Imperial’s request.

Chambliss’ office claims that the Senator was only advocating for the victims of the fire by asking tough questions. His office also says that Chambliss did not respond to the memo.

Lawyers for Graham and the victims say this shows that Imperial and Chambliss worked together to discredit Graham. One attorney representing some of the victims also claims that Chambliss attempted to talk his clients out of suing Imperial.

In the past, Chambliss has received over $130,000 from sugar interests. This includes money from Imperial’s lobbyists and political committee. In fact, five weeks before the hearing Baker made a $1,000 donation to Chambliss’ campaign.

Imperial is now facing an $8.8 million fine from OSHA for safety violations at its refineries as well as lawsuits from the Port Wentworth fire.

Pate & Brody is an accomplished Georgia law firm with offices in Atlanta, Macon and Madison. Our lawyers are dedicated to pursuing justice for crime victims, people who have been defrauded by deceptive business practices, or injured through the fault of others. Our lawyers have been recognized on the list of Georgia's "Super Lawyers", and included among Georgia's "Legal Elite" by Georgia Trend Magazine.

A Winder, Georgia man will collect $720,000 (and his lawyer will recover at least $318,000 in legal fees) as part of a settlement in a whistleblower case the man brought against his former employer, a Department of Defense contractor. The contractor will also have to pay the U.S. Army $4 million as a result of false and fraudulent time claims for work the contractor did for the Army in Iraq.

The Atlanta Journal Constitution has the story.

This case is an example of how effective whistleblower claims can be. There are very powerful laws on the books to help people who want to report fraudulent billings by state and federal government contractors. In many cases, the person reporting the fraud will be entitled to recover a portion of the amount collected by the government and will be protected against retaliation by the contractor.

Our fraud attorneys also assist whistleblowers and other people who want to report fraud against the government. If you believe you have direct knowledge of fraudulent billing practices, or other fraud committed by a government contractor or medicaid/medicare provider, you should call a Georgia law firm experienced in whistleblower claims to discuss a possible qui tam lawsuit or complaint. It could be a very worthwhile phone call.