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COVID-19 Vaccine Fraud and the False Claims Act

COVID-19 Vaccine Fraud and the False Claims Act

So far, more than 414 million Americans have received a dose of the COVID-19 vaccine. In order to ensure an accessible vaccine rollout, the Center for Disease Control ("CDC") has stated that any COVID-19 vaccine must be administered free of charge to the recipient with no additional “office fees'' if the vaccine was the sole reason for the medical visit.

However, some people have reported charges by providers and insurance companies for their coronavirus vaccine under the guise of administration fees or office visits. Already, there have been numerous cases in Chicago, with one man’s bill coming to $281. Another woman received a bill for $27 dollars for her COVID-19 vaccine shot from Jackson Park Hospital in Chicago.

Learn More About Coronavirus Fraud

What Does the Government Require of Vaccine Providers?

All COVID-19 vaccination providers are required to sign a Provider Agreement with the CDC with specific requirements that must be met in order to receive and dispense vaccines. Among those requirements, providers cannot charge or seek any reimbursement from the vaccine recipient and cannot make vaccines harder to obtain through barriers such as network status or requiring additional medical services requirements. Instead, vaccine providers may seek appropriate reimbursements from private insurance providers or federal healthcare programs such as Medicare and Medicaid. If the vaccine recipient is uninsured, vaccine providers can bill the federal government directly for any additional expenses through the Health Resources and Services Administration ("HRSA")’s COVID-19 Uninsured Program.

What are Some Potential False Claims Act Violations Involving the COVID-19 Vaccine? 

Reimbursements from any federal healthcare benefit program, including Medicare, Medicaid, and HRSA’s COVID-19 Uninsured Program, require full compliance with the Provider Agreement, as these terms serve as material conditions of payment. This means that each time vaccine providers submit a COVID-19 vaccine reimbursement claim to any federal healthcare program, they expressly certify that they have complied with these requirements with respect to that administered vaccine dose. 

If the vaccine provider falsely certifies compliance with the requirements of the Provider Agreement, potential for False Claims Act ("FCA") liability arises. In fact, in a warning to vaccine providers who have been charging for vaccines, Acting U.S. Attorney Talbert noted that, "This violation of the terms and conditions of CDC’s vaccination program is also a potential violation of the civil False Claims Act and other civil and criminal statutes." The False Claims Act allows private citizens to sue individuals and businesses that defraud the government. 

An example of a potential FCA violation would be if a provider charged individuals service fees for the COVID-19 vaccine and submitted a claim for that vaccine to federal healthcare programs. Another potential example would be if vaccine providers submitted claims to federal healthcare programs for vaccines that were never distributed. In both instances, if the federal government paid for these claims, it would be disbursing funds that it may not have disbursed if it had known the truth. 

Whistleblowers can play a key role in reporting potential FCA violations involving providers who charge for COVID-19 vaccines. Holding providers accountable helps ensure that cost does not dissuade individuals from getting vaccinated, which in turn protects public health. In addition, whistleblowers who are successful in the FCA suit receive 15-30% of the government’s recovered funds. The FCA also provides whistleblowers with protections from retaliation

What Should You Do if You Encounter Improper Charging or Administration of COVID-19 Vaccines?

If you have insider knowledge regarding any healthcare provider or pharmacy improperly charging for the COVID-19 vaccine, call Goldberg Kohn at (312)-284-3258 or contact us online to discuss a potential FCA case. Our whistleblower attorneys are always willing to provide you with a free, confidential consultation to discuss a potential case.

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