The state of Georgia is cracking down on Medicare and Medicaid fraud.  

If there's any doubt on that score, just look at the two False Claims Act settlements that came out this week – a $20 million settlement with the Medical Center of Central Georgia in Macon, and a $520,000 settlement with Irwin County Hospital in Ocilla.

Mike Bothwell of the Bothwell Law Group in Atlanta, who helped settle the second case in less than 20 months, notes that heath care fraud cases can be complex, but that the law provides real rewards for whistleblowers who step up with insider information that leads to recoveries and an end to fraud schemes.  

In his Irwin County Hospital case, won with the help of co-counsel Brandon Hornsby at the Hornsby Law Group in Atlanta, the whistleblowers walked away with a $130,000 award for helping stop the fraud, and as compensation for the retaliation that followed.

Federal and State False Claims Acts allow private citizens with insider knowledge of fraud, waste, and abuse to bring an action on behalf of the governments in order to stop the fraud.  If the case is won, the government can recover over three times the amount defrauded, and successful whistleblowers can receive between 15 and 30 percent of the governments' recovery.

"It's all about incentivizing integrity," says Bothwell. "Chiselers are always incentivized to cheat. The False Claims Act sets things right by providing a countervailing incentive to do the right thing."

There's no question the False Claims Act works.  Last year, the U.S. government and the states recovered well over $6 billion thanks to whistleblower-initiated cases.

Bothwell notes that a lot of False Claims Act cases involve health care – a situation likely to continue as the Affordable Care Act kicks in.

The Macon hospital settlement involved allegation of upcoding for more expensive inpatient services when the billing should have been for less costly outpatient or observation services.  

In the Irwin County Hospital case, the allegations involved kickbacks for patient referrals and for billing for improperly performed imaging services.

Bothwell notes that it looks like a real fraud-fighting partnership is forming between Georgia Attorney General Sam Olen's Medicaid Fraud Control Unit, the U.S. Department of Justice, and Georgia whistleblowers and their attorneys. 

"We're seeing a real public/private partnership that is bringing a real dividend for the American people. That's exactly how the law is supposed to work."