Fraud Reimbursement

Can you Recover Money from Uncovering a Fraud? 02/20/11

The Ohio Attorney General announced that a $26 million dollar settlement with a company called Care Source, which is a managed health care company. The settlement involved allegations of Medicaid fraud by the company. As a part of the settlement, two people who initially reported the fraud will share in a part of $3 million dollars receive by the Federal Government.

If someone turns in a person or company for cheating the Federal Government, can they receive some of the money?

In certain situations, yes. Under the Federal False Claims Act, if someone knows of a fraud against the U.S. Government, they can sue on behalf of the government and receive between 15-30% of the funds recovered. For example, a recent settlement against a pharmacy company announced by the U.S. Government resulted in five (5) whistleblowers dividing approximately $40 million dollars as their share of the settlement.

What sort of claims are allowed?

The list is unending, but here are some examples:

- Overbilling for medical services;

- Overbilling for prescriptions, such as billing for brand name drugs when generic drugs are actually provided;

- Double billing for supplies to the government;

- Winning a contract through kickbacks or bribes

According to the Taxpayers Against Fraud Education Fund, the Federal Government has received more than $3 billion in settlement recoveries from false claims lawsuits, with 80% coming from the health care industry. However, even something like education has been caught. The University of Phoenix settled a $67 million dollar claim that they paid college counselors to send students to the school.

Why did Congress pass the False Claims Act?

The idea is that the Federal Government just cannot police all of the fraud out there. By providing an economic incentive for individuals, it is hoped that private individuals will help the government catch the crooks.

Does Ohio have such a law?

Presently, there are 28 states that do have laws similar to the Federal Law, but Ohio currently does not have the equivalent of the Federal False Claims Act. If you think you know of a fraud being committed against the Federal Government, you should contact an attorney. You can also go to www.taf.org, which is the Taxpayers Against Fraud Education Fund to start your initial research into the field.