As a whistleblower attorney and former U.S. Attorney, it’s always rewarding to be part of an effort that helps stop Medicaid fraud and returns stolen funds to the government. I recently had the opportunity and privilege to work with a conscientious and selfless whistleblower and my dedicated Carolina Whistleblower Attorneys team to help the government investigate and resolve allegations of serious Medicaid fraud.1
Here is that whistleblower’s story:
Suspicions of upcoding
Diana France is the former Director of Network Management and Contracting for Crossroads, a chain of substance use disorder clinics headquartered in Greenville, South Carolina. She noticed irregularities in the claims that some of the clinics were submitting to Medicaid and suspected that that some of the clinics were upcoding (charging more than they should for the services rendered), resulting in Medicaid being significantly overbilled.
In 2019, Diana enlisted the help of Carolina Whistleblower Attorneys to file a qui tam lawsuit under the whistleblower provisions of the False Claims Act, which prompted a government investigation. After we worked with Diana to gather evidence of her suspicions, we brought the case to the government and assisted the DOJ in prosecuting the case.1
Do you suspect fraud against the government? Discuss your concerns confidentially with us by calling 1-888-292-8852.
Medicaid fraud case resolved
After five years of thorough examination into the allegations, the government was able to recover $863,934 from Crossroads to resolve the case. Our client received a significant reward for her willingness to come forward, report the fraud, and support the government in its investigation.1
How do I know if I have a case?
If you suspect fraud against the government, you may feel uncertain of whether you have a whistleblower case. The following is a list of some fraudulent activities that are usually indicative that a person or organization is stealing from the government (though it is not exhaustive):
- Made false claims for loans or benefits
- Overcharged for good or services
- Delivered less money, property, or services than contracted for
- Billed for services not provided
- Falsified records for the purpose of financial gain
- Produced and/or delivered documentation falsely certifying that the government received property or services
- Purchased or received as a debt any public property from a government officer, employee, or military personnel
- Falsified payment records or statements or concealed, avoided, or decreased those payments
- Knowingly provided defective or dangerous products or drugs via government programs
- Made false claims for payment from the government
Speak with an experienced whistleblower attorney as soon as you suspect foul play with government funds.
How Carolina Whistleblower Attorneys helps whistleblowers
Our team prioritizes the needs of our whistleblower clients, like Diana, as outlined in our formal You-First Policy. We promise to:
- Listen to your concerns confidentially
- Help you decide on the best way forward for you
- Use federal retaliation laws to help protect you
- Fight to get you a maximum award in a successful case
We are led by former U.S. Attorney Bill Nettles, who helped lead the nation in whistleblower recoveries.1,4
If we decide together to move forward, we partner with you to fully investigate your suspicions and build a strong case. We are with you every step of the way, guiding you through the whistleblower process. And we do not accept any fee unless we obtain a reward for you. Guaranteed.2
We’ve represented dozens of qui tam whistleblowers, with tens of millions of dollars in total settlements.1,4 If you suspect fraud against the government, call us before you talk to anyone at 1-888-292-8852 or contact us online for a free and confidential conversation.
You May Also Be Interested In
9 Common Examples of Healthcare Fraud
About the Author
Bill Nettles has dedicated much of his career to advocating for whistleblowers. He spent six years as the U.S. Attorney for the District of South Carolina where he redirected resources to the False Claims Division of the office, bringing the state to a top-4 ranking in the country for whistleblower recoveries during his tenure.1 He is admitted to practice for the U.S. Supreme Court, the U.S. District Court for the District of South Carolina, and the U.S. Court of Appeals for the Fourth Circuit. In addition to serving as a Board Member of the False Claims Division of the Federal Bar Association, Bill has been a frequent lecturer on false claims issues throughout the country.
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Contact the Carolina
Whistleblower Attorneys
If you’re wondering if it’s a good idea to speak with a whistleblower lawyer about what you know, let us set the record straight.
- Corporate ethics hotlines can be risky and may lead to termination. If you’ve already done this, call us immediately.
- Your coworkers could be aware of the fraud – or complicit in it – and you should not talk to them about it.
- The first claim to be filed under the False Claims Act can proceed – if you’re not first, you’re at a serious disadvantage and may get nothing (another reason not to speak to your coworkers about it).
- A confidential discussion costs you a few minutes, but could save you time, stress, and money.
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