Healthcare Fraud Attorneys in Salt Lake City

Providing You with High-Quality Legal Representation

While fraud pervades all aspects of government spending, there is one area that has surpassed all others: Health care. By far, the government is the largest single payer of health care dollars to providers, suppliers, pharmaceutical companies, and the like throughout the United States. This was the case before the Affordable Care Act and will remain so. Government programs go by many names and acronyms: Medicare, Medicaid, Tricare, FEHBP, CHIP, HIP, VA programs, ESRD, and many others.

In 2016 alone, over $2.5 billion was recovered in settlements and judgments involving healthcare fraud against the government. The False Claims Act is the government’s primary remedy to protect taxpayer funds from misuse and redress fraudulent claims for government funds and property. Most of these claims are filed under qui tam provisions which allow citizen whistleblowers to bring fraud cases on behalf of the government. If the government prevails in these cases, whistleblowers receive up to 30 percent of the recovery.

Health Care & False Claims

The health care industry is perhaps the most heavily regulated in the United States. The myriad laws and regulations governing the Medicare and Medicaid programs are not all related to being entitled to payment from these programs, but many are. Hospitals, doctors, durable medical supplies and equipment manufacturers, home health care agencies, laboratories, pharmacies, nursing homes, and rehabilitation facilities all may be subject to the False Claims Act – either federal or state.

Any suspected false claims case that touches on the health care industry is extremely complex. These cases require a team of Salt Lake City healthcare fraud lawyers who have expertise and years of experience not only in false claims cases, but also in health care law and finance.

False Claims Act cases arising from the health care industry include:

  • Billing for services not rendered or billing for a higher-cost service than actually provided (upcoding)
  • Billing for services that are not supported in the medical record
  • Diagnostic fraud, i.e., diagnosing a more severe or different ailment than the one the patient actually has, thereby “justifying” a more costly treatment — or making a nonpayable elective procedure into a medically-necessary payable one (diagnostic miscoding or upcoding)
  • Knowingly providing false or incorrect data on annual hospital or nursing home cost reports
  • Providing materially substandard care. In 2016, the nation’s largest contract therapy provider paid $125 million to resolve claims that it had induced skilled nursing homes to submit false claims to Medicare for rehabilitation services that were not reasonable, necessary, and skilled, or that weren’t provided at all.
  • Providing kickbacks (often characterized as contracts with few, if any, services actually required) to a medical provider to induce the provider to send patients to a particular hospital, use certain services (e.g., a particular laboratory), or prescribe certain drugs or use certain products. In 2016, Tenet Healthcare Corp. paid over $513 million for making kickback payments in exchange for patient referrals.
  • Having a financial relationship with a doctor who makes referrals (and the relationship is not one covered by an exception to the Stark Law, also known as the physician self-referral law)
  • Falsely certifying compliance with federal laws required for payment of a medical claim (usually on claim forms or Medicare enrollment) when the hospital or doctor was not in compliance

Another form of false claim is what has become known as a reverse false claim. In these cases, a person or entity makes a false statement, record, or otherwise takes action to reduce or delay payment of money owed to the government. This situation can arise in many ways. For example, a hospital or healthcare entity may be double paid erroneously by Medicare or Medicaid, or may somehow have a credit balance, which after examination is determined to be owed back to Medicare. Under the False Claims Act, if that money is not refunded within 60 days, it becomes a false claim because the holder of the money is keeping funds it knows are due to the government.

Call us today at (801) 901-3470 to learn more and speak with one of our experienced healthcare fraud attorneys in Salt Lake City.

Testimonials

  • Eisenberg, Gilchrist and Cutt was invaluable in helping us through a difficult time. Our son was involved in a horrible accident and we weren't sure if he would survive. We were dealing with doctors, medical bills, and overwhelming emotions on how we would help our son recover. They answered every question we had and explained the entire process. They went above and beyond for our son and truly ...

    - Kali

  • Jacquelynn handled our case extremely well, she knew what needed to be done to get over an unfair problem with the insurance company and get the case moving and to a reasonable settlement. She had the knowledge of what needed to be done.

    - Yolanda

  • Ms. Carmichael and her team are professional, efficient, and courteous. Resources were expended in a thoughtful manner. Explanations were provided quickly and respectfully when needed. Should the situation arise, I will recommend Jacquelynn Carmichael to both friends and family

    - Former Client

  • We hired Eric for a personal injury case for my son. We were very pleased and satisfied with the level of commitment Eric showed to us and especially our son. He was aggressive to get answers and made us feel as ease with such a hard time in our lives. We felt confident in his ability from the moment we meet him and he did not disappoint. We feel he was very fair.

    - Brett

  • I would recommend Eric Olson to anyone. He was very professional and strived to educate me in making the best decisions when I had no idea how to decide what to do. He is very knowledgeable about his particular field of law and used that in my best defense. I am very pleased with the job that he did for me.

    - Lauren

  • I was in an auto accident three years ago. The first auto accident I have ever been in, but the other driver was ticketed. This lead to slow and obvious pain that grew worse. Doctors, surgery, shots, emotional trauma from not being able to physically do things I used to. That being said I want it known that Eric Olsen was so right for the lawyer to handle this case for me. I originally hired a ...

    - Jenann

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