Lawsuit Loans And Settlement Loans: Combating Health Care Fraud And Abuse

Health Care Fraud

Although of fairly-recent origin, lawsuit loans and settlement loans are becoming more widely known. Individuals are relying on various forms of lawsuit funding to assist them in being able to continue litigation against those who cause them harm through health care fraud. In the vast majority of instances, litigation funding can be extremely valuable to individuals who file legitimate claims.

However, for those individuals who are intent on health care fraud, you should be aware of the fact that incorporating various forms of litigation funding will give a second pair of eyes to this situation that may be unwanted!

I realize that it appears incongruous to suspect that there is some logical consistency in what I’ve stated. However, please note that all lawsuits require various levels of scrutiny prior to getting to the final process. If a lawsuit is filed against health care fraud, this typically means that the underlying negotiations have failed. This isn’t always the case. Why? Because some attorneys opted to file a lawsuit as soon as a client comes to them.

When individuals seek lawsuit loans and settlement loans, they are advised to work with brokers who will attempt to connect them with litigation funding agencies that are best-suited to accommodate their needs. Additionally, various jurisdictions limit the types of funding that may be advanced and brokers can be tremendously valuable to applicants.

When applications are filed, many of these funding agencies work closely with health care lawyers and underwriters who have a great deal of experience in reviewing such matters. If fraudulent activity is suspected on a particular file, this may trigger the need to report concerns to law enforcement. Remember, there is no attorney-client privilege in documents being submitted. Therefore, you should be cognizant of the need to reserve this form of funding for those cases that are legitimate.Learn more detailed updates at http://www.seventhcircuitcases.com/dont-fall-victim-to-health-insurance-fraud-3-ways-to-protect-yourself/

Fortunately, the vast majority of cases that are filed are pristine. However, for myriad reasons, some individuals will attempt to take unfair advantage of a defendant through health care fraud. Illustrative of this is the case in which a plaintiff’s car may have only a tiny scratch on it and yet submit bills for tens of thousands of dollars. (Yes, severe injuries can occur in minor incidents. However, they are the exception rather than the rule.)

Keep in mind, lawsuit loans and settlement loans were created in an effort to even the playing field. Plaintiffs customarily must do battle with insurance carriers and their health care lawyer. It isn’t simply a matter of plaintiff versus defendant. In those cases in which no insurance is involved, many individuals find that it’s not even worth their while to pursue compensation for harm they sustained.

Health Care Fraud

The vast majority of cases that we see arise from car accidents. Most states require insurance coverage – by law. Failure to maintain this insurance while operating a vehicle can constitute a crime in most states. Therefore, the vast majority of cases involving car accidents will have a component in which a plaintiff must deal with both the defendant and the defendant’s insurance carrier. Remember, when you deal with an insurance carrier, you are often dealing with very experienced insurance defense attorneys who focus their attention solely on representing insurance companies. (It is true that defense attorneys state that they represent the defendant, not the insurance carrier. However, this is absolute fiction.)

Those in need of lawsuit loans and settlement loans should pursue them with the assistance of a broker. Make certain, however, that your claim is legitimate and you are not causing health care fraud. If you are attempting to perpetrate a fraud, in addition to being advised not to perpetrate the fraud in the first place, you certainly create double-trouble for yourself if you submit these claims to lawsuit funding agencies. If you in any doubt contact a health care lawyer today.…

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Five Physicians Plead Guilty to Health-Care Fraud – An Important Lesson For Physicians

Physicians

The United States Attorney in Boston recently announced the settlement of a health care fraud case involving five urologists and TAP Pharmaceutical Products, Inc., a major American pharmaceutical manufacturer. The government alleged that the urologists received illegal inducements from TAP to prescribe the drug Lupron in the 1990s. The physicians pleaded guilty to health care fraud, and TAP agreed to pay $875 million to settle allegations of fraudulent drug pricing and marketing of Lupron.Visit my latest blog posted at http://www.seventhcircuitcases.com/dont-fall-victim-to-health-insurance-fraud-3-ways-to-protect-yourself/

TAP markets Lupron for the treatment of advanced prostate cancer. The U.S. Attorney initiated an investigation into TAP’s pricing and marketing of Lupron in 1997, after a urologist employed by an HMO reported to law-enforcement authorities that he was offered an educational grant to reverse a decision he had made on behalf of the HMO to exclude coverage for Lupron.

To induce physicians to prescribe Lupron instead of a cheaper alternative, TAP gave physicians free samples of the drug, worth as much as $40,000, as a form of volume discount. The average cost of a monthly dose of Lupron was $400 to $600. Because Lupron must be injected under the supervision of a physician, Medicare, which normally does not reimburse for medication, reimbursed physicians 80% of their administration cost. The remaining 20% was reimbursed by the patient as co-pay. TAP fully intended and expected the physicians to prescribe the free Lupron to their patients and then bill the patients and their insurers the average wholesale price of the drug. That is precisely what the physicians did.

As a further incentive to encourage physicians to prescribe Lupron, TAP offered them free consulting services, free trips to golf and ski resorts, and money disguised as “educational grants,” that the physicians used to pay for cocktail parties, office Christmas parties, medical equipment, and travel expenses. The Government described these items as kickbacks and bribes used to influence the physicians to prescribe Lupron.

The TAP case is likely to have a significant impact on the marketing practices of not only pharmaceutical companies, but on all health care vendors. For physicians, the message should be loud and clear.

First, physicians need to carefully examine some of the perks they are used to receiving from health care product and service vendors.

The Federal government cited as illegal inducements many of the marketing practices typically utilized by pharmaceutical companies and other health care vendors, including: free products, free consulting services, trips to golf and ski resorts and money purportedly for “educational grants” but used for other purposes. Thus, physicians who accept free services, free products, or money from vendors risk criminal charges and civil liability.

Physicians

It is known as health care fraud and therefore a felony under the Medicare-Medicaid Anti-kickback statute (42 U.S.C. 1320a-7b) to receive or solicit payment in exchange for ordering an item, such as a prescription drug, reimbursable by Medicare or Medicaid. This statute was expanded to apply to all federal health care programs under the Health Care Portability and Accountability Act (HIPAA).

In terms of civil liability, physicians who knowingly submit false claims for reimbursement by the federal government can incur civil penalties of up to $10,000 per claim, plus treble damages, under the Federal False Claims Act (31 U.S.C. 3729-3732). At $10,000 per claim, civil monetary penalties often reach millions of dollars. For example, TAP’s $875 million penalty included over $559 million to settle its federal civil False Claims Act liability in the Lupron case.

Second, physicians need to realize that the Government is paying close attention to their interactions with manufacturers and vendors of health care products and services. The TAP case highlights the government’s increased vigilance in investigating and prosecuting violations of the fraud and abuse statutes. In a six-month period (April through September 2001), the Government recouped more than $1.22 billion through both Civil Monetary Penalty Law and False Claims Act civil settlements. Physicians should stay tuned to further developments in this area. If you are in any doubts, contact a health care lawyer today.…

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Don’t Fall Victim to Health Insurance Fraud! 3 Ways to Protect Yourself

Cheap health insurance

Cheap health insurance plans have been developed so that a person who has no coverage by their employer can find insurance coverage on their own. These low cost health insurance policies can also be very beneficial to someone who has left a 9-to-5 job to go into business on their own. Often the low cost of these policies allow for savings to put toward other forms of expense.

Sometimes, an inexpensive health care plan is designed to target retirees and elderly people who can’t negotiate the rate a large business could. Whatever your situation is, whenever you are considering a new health insurance policy you should do your homework ahead of time, so that you don’t regret it later.

What are the three ways you can be caught in the scam of health care fraud?

1. Be wary of insurance agents who try to sign you up quickly because they offer you a “special deal.” Typically these are the insurance providers who will pay for a small premium amount and lesser medical claims. However, they could vanish overnight if a more expensive claim has been filed or if regulators begin to scrutinize their behavior.

How would you know if health care fraud is a risk with your insurance company? If it is a smaller and lesser known insurance company and if you have been getting your claim delayed and they have been making excuses and not making payments. In this case it is in your best interest to go to the Better Business Bureau or the Attorney General’s office. If you are a small business owner you should be very careful about choosing an insurance company that is not familiar to you as you could wind up being liable for the unpaid medical bills your employees generate.

2. Secondly, be careful to make sure the health insurance plan you’ve signed up for is licensed by the state insurance commissioner. Your state insurance commission regulates legitimate insurance companies operating within your state. If a health plan isn’t listed with them then a company is more than likely fake and could lead to health care fraud.For more information, visit their official website.

Cheap health insurance

3. Insurance scams operate by offering policies that appear very attractive and hard to resist when first presented. If you find yourself being tempted by an unusual amount of coverage that doesn’t seem to be in line with the other plans you consider, it’s time to do your homework and dig deeper before signing anything or committing yourself. Illegitimate insurance providers try to make an offer irresistible; once they have sold a large number of policies they disappear, taking your money with them.

If you wonder if it’s possible in this day and age for companies like this to exist, watch the John Grisham legal thriller “The Rainmaker.” Keep in mind, where there is a dollar to be made people are going to try to make it, even if it means taking advantage of somebody in a deceitful and sleazy way.

Click here to find out more information about health care fraud and don’t be a victim on it or contact a health care lawyer today.…

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