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Maverick, Lawyer
Category: Criminal Law
Satisfied Customers: 5735
Experience:  20 years experience
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I am a physician who was employed by another physician. He

Customer Question

I am a physician who was employed by another physician. He is fraudulently billing Medicare and instructed the entire office as to the improper codes that were to be used. After being warned twice by his own internal auditor he insisted on continuing this practice. He recently terminated my contract and I would like to report him to CMS. Can I or other staff members also be held liable for fraud for working as directed?
Submitted: 2 months ago.
Category: Criminal Law
Expert:  Maverick replied 2 months ago.

Welcome! My name is Maverick. Please give me a few minutes to analyze and/or research your inquiry and I will be back.

Expert:  Maverick replied 2 months ago.

According to the law below, it appears that anyone who presented the fraudulent claim may be held accountable.

31 U.S.C. §3729(a), the Civil False Claims Act, provides that anyone who presents to a government employee a false or fraudulent claim is liable for a civil penalty of not less than $5,000.00 and not more than $10,000.00 plus three times the amount of damages that the government sustains because of the action. This liability is per occurrence.

Customer: replied 2 months ago.
I think you may have misread my question. I am not wishing to report a false claim to the government. I am wanting to report an accurate claim to the government regarding my precious employer and want to know if I would also be liable.
Expert:  Maverick replied 2 months ago.


If you still want to go forward with a live phone call, please let me know. I am online at the moment. You will need to initiate the phone call from your end and input your phone number as the calls are routed through JA's computer system.

Expert:  Maverick replied 2 months ago.

Please disregard the above post as it was for another customer.

In response to your question, what I am saying is that the statute by which the government prosecutes medicaid fraud is false claims act and under it anyone who presents the false or fraudulent claim is accountable and anyone who direct that such claim be submitted is accountable under the theory of vicarious liability.

Customer: replied 2 months ago.
Ok, I understand, however, if the claim is deemed to be relevant can I, or anyone else in the office, who "participated" as instructed by our employer be held responsible by Medicare for fines and/or repayment? As employees we were fearful for our jobs. Now that I am no longer employed I would like to report his willful and intentional effort in defrauding the Medicare system.
Expert:  Maverick replied 2 months ago.

Yes, that is what I am saying that. For example, the non-physician staff that presented the fraudulent claim can be held accountable as well. The law provides employees protection under the Whistle Blower Act so that they cannot lose their jobs for reporting such violations instead of participating.

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