Whistleblower LawAdam Law is proud and honored to represent whistleblowers. Also known as qui tam relators, whistleblowers are courageous individuals who are willing to speak up about fraud committed on the Government at the expense of American taxpayers.
Whistleblowers may sue under the federal False Claims Act and other laws to recover taxpayer funds and to share in a portion of the recovery. Any person or business with knowledge of a fraudulent scheme that affects taxpayer monies may qualify as a whistleblower.
Adam Law is engaged in numerous pending qui tam actions and investigations involving Medicare fraud, illegal kickbacks, false statements, unlawful billing, medically unnecessary physician services, and other fraudulent schemes that drain precious taxpayer funding from important Government programs, and in some instances threaten patient safety.
“Men must turn square corners when they deal with the government.”–Justice Oliver Wendell Holmes, Jr. (Rock Island, A. & L. R. Co. v. U.S., 254 U.S. 141 (1920))
Following national trends, Adam Law’s whistleblower practice has a primary focus on healthcare matters. In healthcare and other industries, fraud schemes boil down to lying, cheating, and stealing from American taxpayers.
Whistleblowers embody the fundamental American ideal that no one is above the law. But by speaking up, whistleblowers risk potential adverse consequences for their careers, families, and livelihoods. They often feel alone and isolated, having been ignored when voicing concerns about potential fraud. Adam Law stands by you and fights on your behalf to enforce the law and remedy the fraudulent practices you have witnessed.
Contact Adam Law to Report Fraud Involving a Government Program
False Claims ActThe federal False Claims Act and counterpart state laws protect and encourage whistleblowers who report fraud that has caused the Government to lose money. See 31 U.S.C. § 3729. A whistleblower may file a federal lawsuit in the name of the United States alleging that the defendant has violated the False Claims Act by knowingly submitting false claims or false statements to a Government agency or contractor to obtain money, or to avoid a duty to return money owed to the Government. As a reward, the Relator is entitled to a share of the amount recovered for taxpayers.
In FY 2021, the U.S. Department of Justice recovered over $5.6 billion under the False Claims Act, with over $5 billion in matters that involved the health care industry.
As a federal prosecutor, Ms. Adam prosecuted criminal fraud that victimized federal government programs, agencies, and individuals. In private practice, Ms. Adam has investigated and litigated False Claims Act whistleblower cases for over 20 years. She has served as an expert witness on compliance with the Anti-Kickback Statute and remedies under the False Claims Act. Ms. Adam's experience includes kickbacks and Stark Law violations, Medicare overpayments, medical necessity, Medicare and Medicaid upcoding and fraudulent billing, Medicare conditions of coverage for cardiology procedures and other medical services, the Medicare Secondary Payer Act, and other laws and regulations governing federal healthcare programs.
Healthcare FraudFraud schemes distort the healthcare marketplace because fraudsters prioritize their own enrichment over patient care and compliance with the law, and their schemes often create unfair competition for honest healthcare providers and suppliers.
Adam Law believes that nailing fraudsters in the healthcare industry protects the integrity of our healthcare system and serves all of its many stakeholders – American taxpayers, patients, and honest healthcare providers and suppliers, who deserve a level playing field.
Healthcare is the dominant industry in whistleblower litigation, nationally and at Adam Law. Ms. Adam’s healthcare background and litigation experience give Adam Law the tools to litigate a range of healthcare cases under the False Claims Act, from open-and-notorious Medicare fraud to more nuanced fraud schemes requiring sophisticated knowledge of the False Claims Act and healthcare fraud and abuse laws such as the Overpayment Law, the Anti-Kickback Statute, and the Stark Law.
There are many types of healthcare fraud, and one common scheme is to knowingly retain funds received from the Medicare or Medicaid programs that the recipient is not entitled to retain and has a duty to refund. Federal law prohibits this practice. A person who receives overpayments generally is required to report and return the funds within 60 days of identifying the overpayments. Knowingly failing to return taxpayer monies is a violation of the False Claims Act and a basis for bringing a whistleblower case.
Federal law prohibits physician self-referrals, meaning a physician generally may not refer Medicare patients to an entity with whom the physician has a financial relationship. See 42 U.S.C. § 1395nn.
The purpose of the Stark Law is to ensure that medical decision-making is based upon the patient’s best interests rather than the financial incentives of the physician. Medicare does not pay for services that result from physician self-referrals, and a person violates the False Claims Act by knowingly requesting Medicare payment for services that resulted from an unlawful self-referral in violation of the Stark Law. A Stark Law violation thus is often the basis of a whistleblower case.
Congress passed the Anti-Kickback Statute in 1972 and has enhanced it many times since then to curb fraud and abuse in federal healthcare programs. The Anti-Kickback Statute makes it a crime to offer, pay, or accept anything of value if one purpose of the arrangement is to induce a person to refer patients for healthcare services or supplies that are paid for in whole or in part by Medicare, Medicaid, TRICARE, or other federal healthcare programs. See 42 U.S.C. § 1320a-7b(b).
A central purpose of the Anti-Kickback Statute is to ensure that decisions about medical care are based upon the best interests of patients, rather than on the influence of payments or other remuneration from someone seeking patient referrals. Congress also passed and strengthened the Anti-Kickback Statute based on its concern that kickbacks create unfair competition in the healthcare market and can drive honest companies out of the market, to the detriment of patients.
In 2010, Congress strengthened the Anti-Kickback Statute and tied it to the whistleblower law. The Anti-Kickback Statute now establishes that a claim for payment submitted to a federal program such as Medicare that includes “items or services resulting from” a kickback scheme “constitutes a false or fraudulent claim” in violation of the False Claims Act. See 42 U.S.C. § 1320a-7b(g).
"The federal anti-kickback statute is the guarantor of objective medical advice for federal health care program beneficiaries and helps ensure that providers refer patients based on the patients' best medical interests and not because the providers stand to profit from the referral.”OIG News Release, Inspector General Announces Eight New Anti-Kickback Statute Safe Harbors, November 18, 1999.
Thus, claims submitted to Medicare, Medicaid, TRICARE and other federal healthcare programs are not eligible for payment if they are for services or supplies that result from an unlawful kickback scheme. A person violates the False Claims Act by knowingly requesting payment from a Government healthcare program for services that resulted from a kickback scheme.
Kickback schemes, therefore, are often grounds for whistleblower lawsuits. Adam Law represents clients alleging kickback violations and other abuses of federal healthcare laws and regulations.