Suspected Medicaid fraud can affect healthcare programs, taxpayers, and patients who rely on essential services. Before filing a qui tam complaint, it is important to gather accurate information so that investigators can properly evaluate the allegation.
Taking a few careful steps beforehand can strengthen the quality of your complaint, and help authorities understand what occurred.
Confirm the details of the suspected conduct
Before making a report, take time to review what you observed. Medicaid fraud can involve false billing, kickbacks, misuse of services, falsified records or other improper conduct.
Make sure you can clearly identify the actions that caused concern and distinguish facts from assumptions or rumors. Your attorney will help you with this.
Identify the people or organizations involved
Accurate identification is important when reporting suspected wrongdoing. Gather the names of individuals, healthcare providers, businesses or facilities connected to the activity.
Having clear identifying information can help investigators direct their review to the correct parties without unnecessary delays. Again, your attorney can help you with this.
Record dates and important events
Create a timeline of when the suspected conduct occurred. Even approximate dates may be helpful if exact information is unavailable.
Documenting the sequence of events can provide context and help investigators understand the nature and scope of the allegation. This will be reviewed by your attorney before being submitted to the government.
Collect supporting documentation
If records are available, gather copies of relevant documents that support your concerns. Examples may include billing statements, correspondence, appointment records or other materials related to the issue. It is important that you only gather copies of documents that come across your desk in the normal course of business.
Identify possible witnesses
Consider whether other individuals may have observed the same conduct or possess information that could help verify the allegation. Witness information can be valuable during an investigation and may help confirm important facts surrounding the reported activity. Your attorney will share this witness information with the government.
Prepare a clear explanation
Before filing your complaint, you and your attorney should organize the information into a concise description that explains who was involved, what happened, when it occurred and why you believe the conduct may be improper.
If you have concerns about your rights, responsibilities, or the reporting process, seeking reliable legal guidance may help you better understand your available options before proceeding.