Bo Frith

What are medically unnecessary procedures?

Medically unnecessary procedures are health care items and services that are not “reasonable and necessary for the diagnosis or treatment of illness or injury.”[1] The False Claims Act provides a mechanism for individuals to “blow the whistle” on instances of waste, fraud, or abuse for systemic unnecessary procedures in healthcare settings. Individuals who bring a

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Why People Become Whistleblowers

There are many reasons why an individual “blows the whistle.” The debate often centers on whether these individuals are frivolous, disgruntled employees seeking financial gain or people with legitimate concerns who suffered personal loss. A wealth of academic research clearly shows it is the latter. The False Claims Act is the primary vehicle empowering whistleblowers

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Outside Whistleblowers Exposing Healthcare Fraud

  The typical whistleblower is often an aggrieved employee who brings to light his employer’s fraudulent conduct. These individuals, often called internal whistleblowers, are important in combatting healthcare fraud. There remains, however, a different kind of whistleblower. Some whistleblowers are individuals or entities that are not employed by the company who committed the wrongdoing. These

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Illegal Kickbacks and Referrals in Healthcare Fraud

A whistleblower may bring a variety of different allegations of healthcare fraud. One such allegation concerns improper referral fees. Whistleblowers can bring a lawsuit for this type of fraud through the Anti-Kickback Statute and the Stark Law. The Anti-Kickback Statute and Stark Law prohibit medical providers from paying or receiving financial compensation, or anything of

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Nursing Home Whistleblowers and Qui Tam Cases

The False Claims Act is the government’s primary tool in addressing the misuse of taxpayer funds. Since 2017, the U.S. Department of Justice recovered approximately $11.4 billion under the False Claims Act.[1] Of the $11.4 billion recovered over the past four years, approximately 90 percent or $9 billion was recovered in health care fraud matters.[2]

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Healthcare Fraud at Universities

Earlier this month, the University of Miami agreed to pay $22 million to resolve a lawsuit brought under the False Claims Act for fraudulent healthcare billing.[1] Four former healthcare executives at the University of Miami filed the suit. The Department of Justice will award the whistleblowing executives a share of 15% to 25% of the

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Investment Fraud

Earlier this month, a federal jury in Virginia convicted a Florida banker and Virginia attorney of running a fraud scheme that swindled more than 300 victims, most of them seniors, out of more than $25 million.[1] Following a month-long trial, the jury found Daryl Bank of Florida and Billy Seabolt of Lynchburg, Virginia guilty of

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Medical Malpractice and Whistleblower Claims

Our law firm has a fairly unique practice…we represent patients in medical malpractice cases against health care providers and whistleblower cases on behalf of honest folks who report cases of financial and billing fraud.  I recently learned of a case which deals with both issues: a whistleblower on illegal kickbacks for unnecessary back surgeries. South

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Healthcare Fraud: Inflated Medicaid Billing

Healthcare providers violate the False Claims Act by knowingly submitting false claims for payment to government insurers. One of the most frequent sources for whistleblower lawsuits is inflated Medicaid billing. In September of 2020, a Virginia mental health agency agreed to pay over $250,000 to settle a false claims act lawsuit.[1] Victoria Transcultural Clinical Center

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Financial Fraud

A recent article in the Roanoke Times details the explosive growth in whistle-blowing lawsuits during the pandemic, especially for financial fraud. In the fiscal year that ended September 30, the U.S. Securities and Exchange Commission received 6,900 tips alleging while collar crime, 31% jump from the previous 12-month record. Whistleblowing can be quite lucrative. Since

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