How to File a Qui Tam Lawsuit for Medicare and Medicaid Fraud in Indiana

Healthcare fraud drains billions of taxpayer dollars annually. If you work in the medical industry in Indiana and discover that your employer is overbilling the government, you hold significant power to stop it. The law empowers private citizens to file lawsuits on behalf of the government-a process known as a 'Qui Tam' action. Because taking on a hospital network or nursing home can be intimidating, the law also offers substantial financial rewards and strict anti-retaliation protections. You can find an experienced whistleblower attorney in our directory to help you file your claim properly and protect your career.

Understanding the False Claims Act in Indiana

Filing a Qui Tam lawsuit involves both federal and state laws. At the federal level, the False Claims Act under 31 U.S.C. § 3729 makes it illegal to knowingly submit false or fraudulent claims for payment to government programs like Medicare. In Indiana, the state has its own mirror legislation. The Indiana Medicaid False Claims and Whistleblower Protection Act, found at Ind. Code § 5-11-5.7-2, protects the state's Medicaid funds. When a lawsuit is filed, it is submitted 'under seal' (in secret) at a federal court, such as the U.S. District Court for the Southern District of Indiana, Indianapolis or the U.S. District Court for the Northern District of Indiana, Hammond. This secrecy allows the Indiana Attorney General's Office, Indianapolis and the Department of Justice to investigate without tipping off the fraudsters.

Upcoding by Medical Billers

One of the most common forms of healthcare fraud in Indiana is 'upcoding.' This occurs when a medical billing specialist or physician intentionally submits a billing code for a more complex and expensive procedure than the patient actually received. For example, billing for a comprehensive 45-minute consultation when the doctor only spent five minutes doing a routine checkup. If you are a biller or coder in Fort Wayne or South Bend and are ordered to routinely upcode Medicare claims, you may have grounds for a Qui Tam lawsuit.

Phantom Billing in Nursing Homes

Nursing homes and long-term care facilities sometimes engage in 'phantom billing.' This egregious practice involves billing Medicare or Indiana Medicaid for treatments, medications, or therapies that were never provided. In extreme cases, facilities have billed for services allegedly provided to patients who had already passed away or had been discharged weeks prior. Precedents in the 7th Circuit, such as United States ex rel. Absher v. Momence Meadows Nursing Center, Inc., 764 F.3d 699 (US 7th Circuit Court of Appeals 2014), demonstrate how courts scrutinize worthless or phantom services provided to vulnerable elderly patients.

Kickbacks (Stark Law) in Hospital Networks

Federal law severely restricts financial relationships between doctors and medical facilities. The Anti-Kickback Statute, 42 U.S.C. § 1320a-7b, and the Stark Law, 42 U.S.C. § 1395nn, prohibit hospitals, laboratories, and pharmaceutical companies from offering financial incentives, lavish gifts, or luxury trips to doctors in exchange for patient referrals. If an Indiana hospital network is paying physicians 'consulting fees' that are actually thinly veiled bribes for Medicare referrals, an insider can file a whistleblower claim exposing the illegal kickback scheme.

Falsifying Patient Records by Home Health Aides

Home health care is a rapidly growing sector in Indiana. Unfortunately, it is also highly susceptible to fraud. Agencies may pressure nurses and home health aides to falsify patient logs to make it appear that they visited a home daily when they only visited once a week. They may also alter a patient's medical records to falsely certify that the patient is 'homebound,' which is a strict requirement for Medicare to cover home health services.

How Much Does a Whistleblower Lawyer Cost?

You do not need to pay thousands of dollars upfront to expose corporate fraud. Whistleblower attorneys almost exclusively work on a contingency fee basis. This means they advance all the costs of the investigation and litigation. The attorney only gets paid if the government successfully recovers funds, typically taking a percentage of your final whistleblower reward (usually 33% to 40%).

How Long Does a Qui Tam Lawsuit Take?

Qui Tam lawsuits require immense patience. Because the case is initially filed under seal, the government has 60 days to investigate, but prosecutors almost always ask the judge for extensions. It is very common for an Indiana whistleblower case to remain under seal for 1 to 3 years while the Indiana Medicaid Fraud Control Unit, Indianapolis issues subpoenas and reviews thousands of medical records. If the case proceeds to litigation, it could take an additional 2 to 4 years to resolve completely.

Frequently Asked Questions (FAQ)