The U.S. Department of Health and Human Services has found that fraud in mental health facilities is a systemic problem. Whether in a skilled facility memory center, a behavioral health ward in a hospital, a drug rehabilitation facility, or outpatient service, fraud jeopardizes the mental healthcare sector and the well-being of the patients it serves. For this reason, financial rewards are available to brave individuals who blow the whistle on healthcare fraud in mental health facilities.
Newman & Shapiro, located in Massachusetts, provides first-rate representation to mental healthcare whistleblowers. If you are a whistleblower reporting fraud in a mental health facility, our experienced whistleblower attorneys will guide you through the justice system and help you report the fraudulent activity. When you become our client, you can rest assured our legal team will help you obtain the financial reward you deserve.
What is mental health facility fraud?
Fraud can occur in mental health facilities such as nursing homes, residential facilities, and community mental health centers, and may involve psychiatrists, psychologists, and other mental health professionals often in the context of questionable billing including to Medicare, Medicaid, and/or Tricare.
It is worth noting that Medicaid is the single largest payer of mental health services in the U.S. Many therapy providers refuse to take patients with Medicaid due to low reimbursement levels for behavioral therapy in this government program, however. In addition, Medicare covers certain outpatient services administered by psychiatrists, clinical psychologists, nurse practitioners, physician assistants, and other approved providers.
Because Medicare is a federal program, and Medicaid is a joint state/federal program, mental healthcare fraud can result in state and federal charges. At the federal level, the strongest tool to combat mental health facility fraud is the False Claims Act (FCA), which is designed to protect the government from being overcharged for goods and services.
Under the qui tam provisions of the FCA, whistleblowers with evidence of fraud against Medicare and Medicaid can sue the perpetrator on behalf of the government. A whistleblower (or “relator”) who provides actionable evidence of fraud may be awarded a portion of the recovered funds.
Types of Mental Health Facility Fraud
Mental health professionals and service providers can engage in a variety of fraudulent activities, such as:
- Services not provided/double billing — Billing Medicare or Medicaid for services not being performed or padding claims with additional hours
- Upcoding — Providing a service and billing the government for another service with a higher authorized reimbursement amount (e.g. billing group therapy as multiple individual services)
- Services not medically necessary — Billing for behavioral health services that are not medically justified, such as therapy that is unlikely to benefit the patient
- Unlicensed employees/unsupervised services — A mental health provider billing for services administered by an unlicensed practitioner without proper supervision
- Unnecessary prescriptions — Ordering and filling unnecessary prescriptions of narcotics or psychotropic drugs for mental health patients
- Kickbacks — Payment of patient recruiters or mental health facility owners for referrals, a practice prevalent in drug rehabilitation facilities
If you have evidence of mental health facility fraud, our whistleblower attorneys can help report your information to the U.S. Justice Department and the Center for Medicare and Medicaid Services, the agency that governs Medicaid and Medicare. In addition, a number of states have enacted versions of the FCA that reward whistleblowers who report Medicaid fraud.
In any event, to have a valid whistleblower claim, you must have original, previously undisclosed information about mental health facility fraud that leads to a fraud conviction. Our legal team will thoroughly assess your information to determine if the conduct rises to the level of mental healthcare fraud, present that evidence to the government, and negotiate a just reward.
How are mental healthcare whistleblowers rewarded?
Awards under the False Claims Act are based on the number of penalties assessed against the mental health care provider or entity. Each offense carries a penalty of three times the amount of the claim plus fines between $5,000 and $11,000, adjusted for inflation, per false claim (in 2019, these penalties range from $11,181 to $22,363). Given that a whistleblower lawsuit may involve hundreds or thousands of claims, the penalties and rewards can be significant. Ultimately, the whistleblower may be awarded 15 to 30 percent of the money recovered by the government.
Contact Our Mental Health Facility Whistleblower Attorneys
While most mental health care professionals provide quality care to their patients, unfair and deceptive billing practices and other unlawful activities in mental health facilities result in significant financial losses for Medicare and Medicaid. At Newman & Shapiro, we are dedicated to rooting out mental healthcare fraud.
Our dependable whistleblower attorneys will offer you informed representation, explain all of your rights and work tirelessly to protect your identity. You should know that the whistleblower laws also protect you against employment retaliation. If your employer has taken an adverse employment action against you (e.g. firing, demotion, pay cut) for being a whistleblower, you may have a legal basis for a civil lawsuit to recover damages such as back pay, attorneys’ fees, and costs.
If you have knowledge of FCA violations in a mental health facility, we can help you obtain the reward you deserve. When you work with our legal team, you will have peace of mind, knowing that we are dedicated to protecting your future and your reputation. Contact our office today to set up a consultation.