Healthcare Fraud

We represent whistleblowers — including several whose identities are currently protected by the False Claims Act — who have reported healthcare fraud involving government money to federal and state authorities.

Healthcare fraud involving false or fraudulent claims for payment by the government can be reported to the appropriate authorities through federal or state qui tam cases under the False Claims Act. Examples of applicable government healthcare includes Medicare, Medicaid, Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), Tricare, Federal Employees Health Benefits (FEHB), Indian Health Service, and more.

Healthcare fraud that can be reported by whistleblowers has more varieties than Baskin Robbins has ice cream flavors. We have represented whistleblowers reporting a diverse range of wrongdoing, including:

• Reporting “upcoding” when medical services were provided, but they were billed under a more complex, expensive, and inaccurate billing code to cause the government to pay more than it should.
• Reporting falsified records used to claim that services were performed when they were not, or to claim they were performed on more days than they were actually performed, causing the government to pay more than it should.
• Reporting claims for medically unnecessary services like inpatient detox substance use treatment, when only a less restrictive level of care (or no care at all) was appropriate, causing the government to pay more than it should.
• Reporting claims for medical services or supplies obtained through illegal referrals in violation of the Anti-Kickback Statute (AKS).

We are experienced in and passionate about helping clients to assess potential whistleblower claims related to healthcare fraud, developing the case, working with the government, and if necessary litigating on behalf of the government.

Note: This page may include matters and descriptions of work completed prior to joining Law Office of Max Rodriguez PLLC.