Medicare Fraud Whistleblower Attorney Kandis Kovalsky Speaks on Declined False Claims Act (FCA) Litigation at the 2023 TAF (The Anti-Fraud) Coalition Annual Conference in Washington, D.C

Philadelphia, PA. - Medicare fraud Whistleblower attorney, Kandis Kovalsky of The Whistleblower Advocates, recently spoke on a panel about Declined False Claims Act (FCA) Litigation at the 2023 TAF (The Anti-Fraud) Coalition Annual Conference, which was held at the Georgetown Washington Marriott in Washington, D.C.

Other panelists included Thomas Greene of Greene LLP, Sarah Frazier of the Law Office of Sarah Frazier, PLLC, and Nimish Desai of Lieff Cabraser Heimann & Bernstein, LLP. The panel focused on hot topics and emerging trends within the Declined Litigation space.

“Declined Litigation” refers to the scenario when the government declines to intervene in a qui tam FCA case filed by a Relator. When the government declines to “intervene,” or take over the handling of the litigation, the Relator’s private counsel may continue to litigate the case. Relators are entitled to a higher percentage of the monies recovered in cases where the government declines to intervene than cases where the government opts to intervene.

The TAF Coalition conference, which was attended by hundreds of whistleblower attorneys, included a three-day deep dive into the latest developments of the False Claims Act (FCA) and other whistleblower programs, strategies to advance the practice of representing whistleblowers, and a celebration of the leaders of the Relator’s bar.

TAF Coalition is a non-profit dedicated to advancing the interests of whistleblowers and fighting fraud against the taxpayers and the government.

Medicare fraud encompasses deceitful activities aimed at obtaining unauthorized benefits from the federal health insurance program, Medicare, primarily designed for individuals aged 65 and older and certain younger individuals with disabilities. Such fraudulent activities vary and may include billing for services not provided, upcoding, unbundling, kickbacks, identity theft, phantom billing, and provider collusion. Beyond financial losses, Medicare fraud undermines the integrity of the healthcare system and jeopardizes patient safety. Perpetrators may face legal consequences such as fines, imprisonment, and exclusion from federal healthcare programs.

Whistleblower lawyers specializing in Medicare fraud cases assist individuals with inside knowledge or evidence of fraudulent activities within the Medicare system in reporting such incidents. The process typically involves discovery of fraud, consultation with a whistleblower lawyer, evaluation and investigation of evidence, filing a lawsuit under the False Claims Act (FCA), government investigation, potential settlement or trial, and recovery of funds, with whistleblowers entitled to a portion of the recovered amount.

Whistleblowers may include healthcare professionals, insiders within healthcare organizations, billing and coding specialists, patients or beneficiaries, and concerned citizens. Medicare fraud whistleblower attorneys provide legal guidance, representation, and support throughout the reporting process, ensuring whistleblowers' rights are protected and potentially leading to financial rewards for exposing fraud.

Medicare fraud whistleblower lawyers are particularly sought in regions with high instances of healthcare fraud, including major metropolitan areas, states with high Medicare enrollment, areas with extensive healthcare networks, and jurisdictions with active law enforcement against healthcare fraud. Fighting medicare fraud is crucial due to its financial impact on taxpayers, strain on the healthcare system, harm to patients, erosion of trust in government programs, and legal and ethical concerns.

Common types of Medicare fraud include billing for services not provided, billing for unnecessary services or supplies, upcoding, kickbacks, and identity theft. Detection challenges arise due to the complexity of the healthcare system and the sophistication of fraudulent schemes. Government agencies like CMS, HHS, and DOJ actively combat Medicare fraud through various tools and strategies, including collaboration with stakeholders, preventive measures, and whistleblower protections. Understanding these facts provides a comprehensive view of the challenges posed by Medicare fraud and ongoing efforts to address them.