Does Your Employer Refer Medicaid Patients to Medical Providers They Own?

Medical providers (physician, dentist, optometrist, chiropractor…) violate state False Claims Acts and commit Medicaid fraud when they refer a Medicaid patient to healthcare providers where they, or their family, have an ownership interest.

If you report Medicaid fraud related to illegal  Medicaid referrals, you could be eligible for a reward under your state’s False Claims Act.

Medicaid Patient Referrals that Violate the Stark Law & False Claims Acts 

The Stark Law places limitations on certain physician referrals for Medicare and Medicaid patients to prevent medical doctors from sending Medicaid patients to any healthcare entity to which the doctor, or an immediate family member, has a financial interest.

Stark Law violations involve three elements:

• A medical provider (physician, dentist, optometrist or chiropractor) or the medical provider’s immediate family member gives a Medicaid patient referral. Must be for a Medicaid patient by a physician or by the physician’s immediate family member (spouse, parent, child, sibling, stepchild, stepparent, in-law, grandparent, grandchild or the spouses of any of those people).
• The referral must be for a designated health service (DHS), including but not limited to durable medical equipment, home health services, laboratory services, occupational therapy, outpatient services, physical therapy, x-ray and radiation therapy.
• A financial relationship must exist between the referring physician or qualified family member and the recipient of the referral. Financial relationships include compensation arrangements, investment interests, ownership or remuneration.

You Could be Entitled to a Money Award if You are the First to Report Illegal Medicaid Referrals 

If you have information regarding a violation of the False Claims Act through Stark Law violations related to Medicaid patient referrals, you may be entitled to a large cash award for reporting fraud.

State False Claims Acts have a whistleblower provision calling for cash rewards of 15 to 30 percent of the money the state recovers for tipsters who were the first to report the fraud with insider information that helps make a Medicaid fraud case. State False Claims Acts also protect tipsters who blow the whistle, making it illegal to fire or harass an employee who reports fraud.