The Law Firm of Piacentile, Stefanowski & Malherbe LLP
Healthcare Fraud

Healthcare Fraud

Whistleblowers who report a healthcare fraud provide an invaluable service to our country since the government spends over $600 billion on Medicare yearly. Some of the biggest profit-driven healthcare companies in the United States took advantage of the honor system, defrauding taxpayers for over $40 billion annually. In the last three decades, the False Claims Act’s Program has become the Department of Justice’s (DOJ) most effective tool to fight this kind of misconduct, with recoveries exceeding $15 billion thanks to the over 4,000 whistleblowers who successfully brought their cases to court. To date, the DOJ paid almost$40 billion in total awards.

What is a Healthcare Fraud?

ambulance in front of a state building

Medicare is a federal insurance program that mostly helps senior citizens paying their nursing facility, hospital, and home health care expenses. Medicaid is a federal-state assistance program that helps impoverished and low-income patients cover their medical expenses. The government and the states pay healthcare providers reimbursements for almost all medical supplies and services, from nursing home care to doctor visits, as well as wheelchairs and knee braces. Medicare and Medicaid are the Federal government’s largest and most expensive healthcare programs. They were originally instituted to benefit well-intentioned physicians and nurses who helped elderly and destitute patients. The most unscrupulous companies saw the vulnerabilities in these programs as a true pot of gold from which they could freely borrow all the money they wanted. In truth, they’re just stealing money from people in their direst time of need.

Billing and reimbursement are self-reporting, so any provider ranging from a local clinic or family dentist to large hospital networks and diagnostic testing laboratories may ask for it. The programs reimburse the provider for most services within 30 days, without requiring any proof that the patient actually received the treatment to be submitted. This makes committing Medicare fraud as easy as checking a different box that pays a higher reimbursement amount than they are owed. The programs lack the monitoring capabilities to make sure that every request for payment is legitimate, and even when overbilling is eventually detected, the company has already spent their improperly earned money or simply disappeared altogether.

What are the consequences of a healthcare fraud?

Healthcare fraud can cause severe damage to patients, including permanent disability and death. It often takes advantage of some of the most vulnerable citizens such as the children, the disabled, and the elderly. Many cases have highlighted dramatic violations of the sanctity of the physician-patient relationship, dishonestly enabling a physician or a healthcare company to financially enrich themselves at the expense of their patients.

As an example of blatantly unethical policies, some hospitals administered a treatment that was less‐effective or even more dangerous than a more medically appropriate alternative, in order to receive a higher reimbursement. In other documented instances, fraudulent practices that saved a clinic several dollars per patient resulted in hundreds of illnesses or death. In 2008, two Nevada endoscopy clinics owned by Derek Desai, M.D. saved $5‐10 per patient by “double‐dipping” syringes back into a single‐use vial of anesthetic. The outrageous practice resulted in 114 patients contracting Hepatitis C and led to multiple deaths. Unfortunately, this is just one example of hundreds, if not thousands of daily instances where remorseless health care providers put profits ahead of patient safety.

How can whistleblowers fight against healthcare frauds?

Malcolm Sparrow, a leading expert on fraud at Harvard University, estimates that this type of fund  siphoning  scam may cost taxpayers as much as $120 billion annually. The Department of Justice regularly relies on doctors and nurses to come forward and act as whistleblowers since all forms of healthcare fraud can be prosecuted under the False Claims Act as. This type of cases has yielded a 15 to 1 return on money devoted to investigating and litigating other illegal misconducts. In May 2009, Attorney General Eric Holder announced the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT). Together with several Strike Forces investigation centers that operate through the country, HEAT has consistently proven to be extraordinarily effective in uncovering large fraud schemes. Between January 2009 and June 2012, the Department of Justice recovered $7.7 billion in cases involving fraud against federal health care programs. The whistleblowers who came forward with the information that resulted in those recoveries received more than $1.5 billion in total rewards.

Why should you choose us to help you file your claim?

In the last decade, we already fought and won dozens of similar battles, and we have the experience and skill required to help you in court. Whistleblowers International’s attorneys and investigators have fought in some of the largest medical fraud cases ever. We have helped many people secure some of the most notable settlements in the history of the United States. Included below is just one example of our past successes concerning healthcare fraud:

  • Warner Chilcott PLC – $125 million for helping the government find illegal kickbacks to physicians, as well as submitting fraudulent prior authorizations.

Types of healthcare fraud

There are dozens of types of fraudulent schemes, and many healthcare institutions have been sued for engaging in multiple illegal practices at once. Below is a list of some of the most common types of illegal Medicare scams.

snippets of content about payments


Is your whistleblower claim valid?

If you took part in any large fraud scheme or witnessed it, you may have a chance of filing a whistleblower claim by reporting the illegal activity in full anonymity. However, to be sure that your case will be successful in court, you should possess enough physical evidence or have access to privileged information to back it up.

Report Healthcare

Become a Whistleblower and join our team today

Taking the first step could be the hardest part, but it’s an ethical duty every U.S. citizen is called upon. Not only you can save hundreds of patients’ lives, but you may also be awarded significant monetary rewards. If you suspect this conduct is happening at a healthcare provider, you should consider helping stop the fraud by blowing the whistle. Our expert legal team will conduct a free case evaluation to help you better understand your legal options and provide you with the knowledge you need to make an informed decision. Your first consultation is free and confidential.

If you delay in filing a claim it can weaken your case and reduce your potential reward, so we urge you to contact us today by filling out a form or calling toll-free at (800) 689-8552.

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  • Focused on Creating a Better World

    Whistleblowers International exists to help whistleblowers with strong information and evidence of wrongdoing against the government bring whistleblower lawsuits, and ultimately to help the next generation avoid these experiences and to prevent future victims. That's what "Committed to Global Transparency" means to us.

  • Practicing with Open Ears and Open Minds

    We are familiar with the intricacies of these cases. You may not know exactly what kind of case your information might pertain to or what exact significance it has. We're the experts in this area and what to decipher that on your behalf. Whistleblower cases are extremely complex and your information may qualify you to initiate a legal action under one of the many kinds of governmental whistleblower programs that exist in the US.

  • A Rare Law Firm of Pure Whistleblowers

    There are many law firms that represent whistleblowers, but very few law firms keep whistleblower cases as their sole focus in the way that we do. We've done this for decades, and we are eager to speak with you.

  • Unmatched Wealth of Knowledge in This Area

    Dr. Joe is both a medical doctor and a licensed attorney who has been in the whistleblowing arena for over 30 years as both a consultant and a whistleblower himself. We want to hear you and see how we can help.

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The information submitted will be submitted to the law firm of Piacentile, Stefanowski & Malherbe LLP d/b/a Whistleblowers International. This communication does not create an attorney-client relationship and is submitted only for the purpose of evaluating your claim to see if this is something we are able to help you with. By contacting us, you certify that you are a potential client making a bona fide inquiry about obtaining legal services to address a potential whistleblowing legal claim. Past results do not guarantee future outcomes. While this submission does not create an attorney-client relationship, all information submitted will be kept strictly confidential per legal ethics rules since this information is submitted in contemplation of a potential attorney-client relationship. No attorney-client relationship is formed until it is determined after evaluation with you that this is something we can take on and a retainer agreement is signed by you and the law firm of Piacentile, Stefanowski & Malherbe LLP d/b/a Whistleblowers International. Please also understand that by submitting your information, there is no guarantee that we will contact you in response, as at any given time, there are only a limited number of claims we are able to take on and pursue. If we do not contact you within 3-business days of your submission, please reach out to another whistleblower law firm if you are interested in pursuing your matter.