The Fraud against Taxpayer’s Act and Federal False claims act protects against medical providers doing unauthorized billing through Medicare and Medicaid or other means. As a private citizen, individuals can sue on behalf of the government if a medical provider bills the government such that it is a violation of the governments rules. This is what’s typically known as a whistleblower.
A qui tam action “[a]n action brought under a statute that allows a private person to sue for a penalty, part of which the government . . . will receive.” If the medical provider bills the government (usually through Medicare or Medicaid) in a way that is a violation of the government’s rules, then a private citizen with information about those violations may sue on behalf of the government. Typically, the private citizen with the information (called a relator or whistleblower) is a person working for the medical provider (billing department or another medical provider). If the lawsuit is successful, then the private citizen may receive a portion of the money recovered through the lawsuit.
New Mexico’s Fraud Against Taxpayer Act delineates specific acts that are not permitted:
A person shall not:
(1) knowingly present, or cause to be presented, to an employee, officer or agent of the state or a political subdivision or to a contractor, grantee or other recipient of state or political subdivision funds a false or fraudulent claim for payment or approval;
(2) knowingly make or use, or cause to be made or used, a false, misleading or fraudulent record or statement to obtain or support the approval of or the payment on a false or fraudulent claim;
(3) conspire to defraud the state or a political subdivision by obtaining approval or payment on a false or fraudulent claim;
(4) conspire to make, use or cause to be made or used, a false, misleading or fraudulent record or statement to conceal, avoid or decrease an obligation to pay or transmit money or property to the state or a political subdivision;
(5) when in possession, custody or control of property or money used or to be used by the state or a political subdivision, knowingly deliver or cause to be delivered less property or money than the amount indicated on a certificate or receipt;
(6) when authorized to make or deliver a document certifying receipt of property used or to be used by the state or a political subdivision, knowingly make or deliver a receipt that falsely represents a material characteristic of the property;
(7) knowingly buy, or receive as a pledge of an obligation or debt, public property from any person that may not lawfully sell or pledge the property;
(8) knowingly make or use, or cause to be made or used, a false, misleading or fraudulent record or statement to conceal, avoid or decrease an obligation to pay or transmit money or property to the state or a political subdivision; or
(9) as a beneficiary of an inadvertent submission of a false claim and having subsequently discovered the falsity of the claim, fail to disclose the false claim to the state or political subdivision within a reasonable time after discovery.
There is no requirement that the medical provider intended to defraud the government. If a doctor, hospital, or other medical provider did violate the Fraud Against Taxpayer’s Act, then they are liable for three times the damages sustained by the state, a civil penalty between $5,000 and $10,000 for each violation, costs, and attorney’s fees. If the medical provider cooperates with the attorney general (along with a few other requirements) then the damages are reduced to up to two times the actual damages rather than three times the damages.
If you suspect fraud against the government and a violation of either the fraud against taxpayer’s act and federal false claims act you can take some time to gather information on the incident. If you feel you need to speak with an attorney to better understand the Fraud against Taxpayer’s Act or discuss your potential case we are available 24 hours a day at 505-242-7200.