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How to Report Medicare Fraud in Your State

September 26, 2023

If you want to report Medicare Fraud in your state, there’s a universal mechanism to report it through a whistleblower lawyer using the False Claims Act, since Medicare is a federally funded program and the False Claims Act addresses fraud against the federal government. Medicare Fraud not only wastes taxpayer dollars but also jeopardizes the health and well-being of countless individuals who rely on the program for essential medical services, so reporting it is essential for the integrity of the system and safety of the patients.

Understanding Medicare Fraud

Medicare is a federal health insurance program that provides coverage to millions of Americans, primarily individuals aged 65 and older, as well as certain younger individuals with very defined conditions.. While the program plays a crucial role in ensuring access to medical services, it has access to hundreds of billions of dollars a year and thus there are instances where dishonest health care practitioners or pharmaceutical companies attempt to exploit it for financial gain. Medicare Fraud refers to any intentional deception, misrepresentation, or manipulation of Medicare services or billing practices that result in financial losses to the program.

The Role of the False Claims Act & How It’s Used to Report Medicare Fraud

The False Claims Act is a federal law that empowers private citizens to act as whistleblowers, to bring lawsuits on behalf of the government when they have evidence of fraud involving government programs, such as Medicare. This law allows individuals to sue entities or individuals who are defrauding the government.

The FCA’s qui tam incentive rewards whistleblowers with 15% to 30% of the recovery as a whistleblower award plus attorneys’ fees and costs for successful actions in addition to attorneys fees and costs. If a whistleblower faces retaliation for exposing the fraud, whistleblowers can get their jobs back and receive money that covers prospective pay, twice the lost pay, interest on lost pay, legal costs, reasonable attorney fees, and costs. However, certain mechanisms inherently protect the whistleblower as the case is filed confidentially under seal and the defendant is unaware of the action for many years, so with one of the best whistleblower law firms you can file your case and plan for your future.

Like All legal cases, deadlines are extremely important. Generally, the False Claims Act provides six years from the wrongdoing to file a lawsuit, but sometimes up to 10 years in special situations. Since each particular claim and statute of limitations to file may depend on very particular facts and circumstances nothing regarding the time to file may be relied on and instead if you’re aware of Medicare fraud you need to speak with a medicare fraud whistleblower lawyer to understand the proper timing of the filing.

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Steps to Report Medicare Fraud in Your State

Consult with a Whistleblower Lawyer: Your initial course of action should be to contact a whistleblower law firm. Firms like Brown, LLC who have an outstanding track record of success representing whistleblowers know the landscape and have obtained hundreds of millions of dollars in settlements and judgments under the False Claims Act (even though past results don’t guarantee future success). You also benefit from contacting a whistleblower law firm because you can find out the best way to handle your case and determine whether you even may qualify for a whistleblower award.

File a Qui Tam Lawsuit: A qui tam lawsuit is the legal mechanism through which a whistleblower initiates a case under the False Claims Act by filing a lawsuit in federal court to report Medicare fraud in any state Your whistleblower attorney will assist you in drafting a complaint outlining the alleged fraud and presenting the evidence you’ve gathered. This complaint will be filed under seal, which means it will be kept private while the government investigates.

Government Investigation: Following the filing of the complaint, the government will conduct an investigation to determine the validity of the Medicare fraud claims. This process generally takes at least a year and the government may request additional information from you during that time.

Government Decision: Following the investigation, the government may decide to become a party to your lawsuit. If they do, they will be in charge of prosecuting the case. If not, you and your lawyer may under certain circumstances still pursue the False Claims Act lawsuit on your own. If the government is in the driver’s seat it’s called an intervention and the relator/whistleblower is limited to 25% of the recovery as a whistleblower reward, if the government doesn’t intervene and you proceed without them and obtain a recovery you can receive up to 30% of what the government recovers as a whistleblower award. However, even though it’s a greater percentage on average the government recovers greater sums if it intervenes and declinations sometimes signal the strength or weakness of a particular case.

Resolution: If your False Claims Act lawsuit is successful and the government recovers funds as a result of it, you may be entitled to a portion of the recovered funds as a whistleblower reward. The reward amount varies but can be substantial.

Alternative Channels of Reporting Medicare Fraud: You can always report Medicare fraud directly to the government, but you are strongly encouraged to speak with a Medicare fraud lawyer first. If you are reporting directly to the government, it may complicate your ability down the road to receive a whistleblower award. However, in certain instances that may be your only route as filing a False Claims Act requires an experienced False Claims Act attorney and cases against beneficiaries of Medicare are not fertile cases to file, so if you want to report for example your neighbor receiving benefits when they shouldn’t be, that would generally be directly reported to the government, but it never hurts to run it by a whistleblower attorney first.

Reporting Medicare Fraud is a civic responsibility that helps protect both the integrity of the Medicare program and the well-being of its beneficiaries. By working with a knowledgeable whistleblower lawyer and utilizing the False Claims Act, you can play a vital role in holding individuals and entities accountable for their actions. If you suspect Medicare Fraud in your state, don’t hesitate to take action – your efforts could make a significant difference in the fight against healthcare fraud.