According to SFGate, a podiatrist, 55- year-old Franklyn J., recently pleaded guilty to submitting false claims to Medicare. The charges allege that Franklyn fraudulently billed Medicare for surgical procedures while only performing minimal undertakings such as clipping the toenails of his patients.

Franklyn had been a practicing podiatrist in Fresno, California.  Government prosecutors claim that Franklyn committed fraud by sending false claims to Medicare between 2010 and 2015. The charges allege that Franklyn received over $141,000 in false medical billings.

On Sept. 3, 2015, Franklyn was indicted on 20 counts of health care fraud charges, including submitting false claims to Medicare.  Franklyn’s sentencing is scheduled for Jan. 16, 2018.  Franklyn faces a potential $250,000 fine and may serve a maximum prison sentence of 10 years.

This is not Franklyn’s first prosecution. In 2012, Franklyn was placed on probation. During that time, he was required to take courses in medical record keeping and prescribing practices.

Reporting Fraud and False Claims to Medicare

A whistleblower is defined as a person who informs on a person or organization engaged in illegal activity.  Whistleblowers are often employees of companies who witnesses their employer committing fraud.  Fraud in government programs costs taxpayers billions of dollars every year. Companies can be involved in a wide range of fraudulent activity against the government.  This can range from false claims to Medicare to illegal government kickbacks and other forms of misconduct.

With the aid of employees who have reported fraud in whistleblower lawsuits, many companies committing health care fraud, financial fraud, tax fraud, Medicare fraud, and government contract fraud have been stopped and charged with these violations. Examples of health care fraud include the following: 1) Providing services that are not medically necessary; 2) Overcharging for medical goods/healthcare services; 3) Kickbacks or illegal payments; and 4) Fraudulent upcoding in medical billing.

The government counts on whistleblowers to assist in fraud prevention. Whistleblowers who file a successful False Claims Act lawsuit, also know as a “qui tam” lawsuit, are often rewarded with 15 to 30 percent of the lawsuit’s monetary award. Whistleblowers reporting fraud, such as healthcare employees, financial consultants, and pharmacists have earned more than $1 billion dollars from whistleblower lawsuits.

In an effort to encourage employees to come forward with whistleblower lawsuits, the federal government rewards the first whistleblower in a company who comes forward, even if the second whistleblower can provide more detailed information.  This is meant to incentivize employees not to hesitate in coming forward with information.

The government provides whistleblowers with various protections once they come forward with allegations.  Whistleblower lawsuits are sent directly to the Department of Justice for further investigation.  During the investigation (prior to indictment), the name of the whistleblower remains confidential.  Whistleblowers also receive various protections under the False Claims Act and other state and federal regulations.  These protections work to prevent companies from retaliating against whistleblower employees.  Companies that retaliate against a whistleblower by firing, demoting, or harassing the employee, may face substantial monetary penalties.