When faced with the dilemma of choosing to report fraud or ignore it, one of the factors to keep in mind is the possibility of fines, or even prison, if and when the fraud is discovered or reported by someone else.
Recently, the medical biller of a Chicago-area visiting physician practice, Medicall, was sentenced to 45 months in prison for her role in a $4 million health care fraud scheme. Mary Talaga was convicted in May 2015 of one count of conspiracy to commit health care fraud, six counts of health care fraud, and three counts of false statements relating to a health care matter. In addition to prison, Talaga was ordered to pay $1 million in restitution. Two other participants were also convicted for their roles in the fraud.
From 2007 to 2011, Talaga and her con-conspirators routinely billed Medicare for services that were never provided, including services for deceased patients and services performed by physicians who were no longer employed by Medicall. These fake procedures equaled more than $4 million in services that were never provided. Medicare paid more than $1 million on those claims.
Talaga's path to prison could have been drastically different if she had chosen to do the right thing and report the fraudulent activities of her employer rather than perpetuating them. At this point in time, Talaga (or any of her co-conspirators) could be enjoying a relator's share of the monies recovered by the Government rather than facing a prison sentence.
Please contact a reputable False Claims Act attorney, like Julie Bracker or Jason Marcus, if faced with this difficult decision. No one can make you report the fraud, but at least you will find out the repercussions for ignoring versus reporting so there are no surprises. Our free evaluations are confidential.