3. Are there any hidden landmines that I need to watch out for in these kinds of cases?
The two most important hidden landmines we look for in Medicare Billing Fraud cases are: (a) anything about potential HHS/CMS regulations and policies that are inconsistent with our theory of the case; and (b) whether the HHS/CMS is going to disagree that the provider should not have gotten paid in whole or in part.
4. How is the amount of the “damages” calculated in healthcare cases?
It really depends on the nature of the fraud. Sometimes it is the entire amount of the reimbursement; sometimes it is the net amount after taking into consideration the value of the goods or services actually provided, and sometimes the amount might even be zero. There are also times with the number of potential damages is reduced by a healthcare provider’s “ability to pay” and whether there is a risk that a needed provider is going to be put out of business. This is a constantly evolving legal issue that has a tremendous impact on relators because they only receive a percentage of what a defendant actually pays the Government.
