Protecting Medicaid Using

The False Claims Act

Dan Hargrove
GovtFraudLawyer.Blogspot.com
What is Medicaid?
Medicaid Cost Taxpayers $406 Billion in FY 2010
(1 in 4 U.S. residents received CHIP or Medicaid)
Current revenues are insufficient to pay
for Medicaid
Texas overall, but especially South Texas,
has a Serious Health Care Fraud Problem
http://www.forbes.com/2009/08/10/health-care-plan-lifestyle-health-obama-
health-care-bill_map.html
What is the False Claims Act?
The False Claims Act is the
Federal Government’s most
powerful tool to combat
procurement fraud

Qui Tam
History of the FALSE CLAIMS ACT

U.S. Army Major Justus McKinstry – the

American Qui Tam God Father
TEXAS HUMAN RESOURCES CODE
CHAPTER 36

Medicaid Fraud Prevention Act

Spotting Qui Tam Cases
 Spotting Qui Tam Cases

Mischarge case:

 Doctor bills
Medicaid/Medicare/TRICARE for
services not actually provided
 Spotting Qui Tam Cases

Upcoding:

 Doctor bills Medicaid for a more

expensive service than actually
provided
 Spotting Qui Tam Cases

Kickback:

 DME Provider pays Doctor (anyone)

for referring patient

 Anti-Kickback Statute (now automatic

False Claim)

 Stark Act
 How does a
False Claims Act
case get started?
Qui Tam
Unique Procedures
of a Qui Tam case
Case filed under seal
Govt investigates while case is
under seal
Whistleblowers are the best way to protect the
Texas Medicaid Program
 Questions
Dan L. Hargrove
(210) 223-9700
dh@hargroverea.com

www.govtfraudlawyer.com
www.govtfraudlawyer.blogspot.com