The Role of Whistleblowers in Reporting Medicare Fraud

March 23, 2023

Medicare is a government-run healthcare program that provides coverage to millions of elderly and disabled individuals in the United States. Unfortunately, Medicare fraud has become a pervasive problem in recent years. According to the Department of Justice (DOJ), billions of dollars are lost every year to Medicare fraud, and it is estimated that healthcare fraud costs taxpayers tens of billions of dollars annually. 

The government relies on whistleblowers to help expose Medicare fraud, and whistleblowers play a critical role in holding healthcare providers accountable for fraudulent activities. Utilizing the False Claims Act, whistleblowers can help keep fraudsters accountable and potentially receive whistleblower rewards up to 30% of what the government recovers.  One of the most effective tools the government has to combat Medicare fraud is through the efforts of whistleblowers under the False Claims Act, the statute that allows insiders to file a qui tam complaint on the government’s behalf using a whistleblower law firm.

What is Medicare Fraud?

Medicare fraud is any intentional deception or misrepresentation made by a healthcare provider or supplier that results in the payment of unauthorized, medically unnecessary, or otherwise false claims. Examples of Medicare fraud include:

  • Billing for services or procedures that were not medically necessary or never provided
  • Upcoding, or billing for a more expensive service than what was actually provided
  • Kickbacks, or offering or receiving payment for referrals of Medicare patients
  • False certification of medical necessity of a service or type of care for a patient

Reporting medicare fraud - The role of whistleblowers in medicare fraud reporting.

What is a Whistleblower?

A whistleblower is an individual who externally reports illegal or unethical activity that exists within an organization. In the context of Medicare fraud, a whistleblower is an insider who has knowledge of systemic fraudulent activities by a company, organization, or healthcare provider and reports those activities to the government through the use of a whistleblower attorney.

Whistleblowers can be current or former employees, contractors, or anyone else with knowledge of fraudulent activities. Whistleblowers play a critical role in exposing Medicare fraud, as they often have inside knowledge of the fraudulent activities.

What Protections Do Whistleblowers Have?

Reporting Medicare fraud can be risky for whistleblowers. They may face retaliation from their employer, such as termination, demotion, or other forms of retaliation. To protect whistleblowers, the government has enacted various whistleblower protection laws, such as the False Claims Act (FCA) and the Whistleblower Protection Act (WPA).

The FCA provides whistleblowers with the ability to file a lawsuit on behalf of the government and receive a percentage of any monetary recoveries resulting from the lawsuit. The law also provides protection against retaliation for whistleblowers who report fraud. Inherently, the whistleblower is initially protected since the complaint is filed confidentially under seal which means the defendant will not know they’ve been sued until the case is unsealed. The case generally stays under seal for many years to protect the identity of the whistleblower while the government is investigating the case. 

The WPA provides protection for federal employees who report misconduct. The law prohibits retaliation against whistleblowers and provides various remedies, such as reinstatement, back pay, and compensatory damages.

How a Medicare Whistleblower Lawyer Can Assist

If you have knowledge of Medicare fraud, it is essential to work with an experienced Medicare whistleblower lawyer or law firm. An attorney can help you navigate the complex legal process, protect your rights, and maximize your chance  to receive any financial compensation in the form of a whistleblower award under the False Claims Act.   

A Medicare whistleblower lawyer can assist in several ways, including:

  • Evaluating your claim to determine if you have a viable case
  • Assisting with the preparation and filing of your claim
  • Representing you in court or administrative proceedings
  • Negotiating a settlement on your behalf
  • Protecting you against retaliation
  • Further, you must use a qui tam law firm to file a case on the government’s behalf under the False Claims Act.

If you are working in the healthcare profession and have realized that your employer is committing Medicare fraud, it can be a highly stressful situation and you will want to report it the right way. It is crucial to report any fraudulent activity to protect your patients and the integrity of the healthcare system. At Brown, LLC, we understand the potential risks and challenges that whistleblowers face when reporting Medicare fraud. Our experienced Medicare fraud lawyers can provide you with the guidance and support you need to report fraud while protecting your rights and interests. We are committed to helping healthcare professionals blow the whistle on fraud and recover the compensation they deserve. 

Frequently Asked Questions

What is the False Claims Act?

The False Claims Act is a federal law that allows individuals to file lawsuits on behalf of the government against those who have defrauded the government. 

Can I receive a financial reward for reporting Medicare fraud?

Yes, whistleblowers who report Medicare fraud may be entitled to receive a financial reward. The amount of the reward depends on the specifics of the case and the amount recovered by the government. In some cases, whistleblowers may receive up to 30% of the total recovery.

What should I do if I suspect Medicare fraud?

If you suspect Medicare fraud, it is essential to report it immediately to an accomplished whistleblower law firm (like Brown, LLC). 

Can I report Medicare fraud anonymously?

Yes, you can report Medicare fraud anonymously, but nothing is truly anonymous anymore. However, if you wish to potentially receive a financial reward, you will need to provide your identity and cooperate with the government’s investigation.

Whistleblowers play a critical role in the fight against Medicare fraud. By reporting fraudulent activity, whistleblowers can help to recover billions of dollars lost to fraud and protect patients from harm. If you have knowledge of Medicare fraud, it is essential to work with an experienced Medicare whistleblower lawyer who can help protect your rights and ensure that you receive any financial compensation you are entitled to. Contact the whistleblower law Brown, LLC at (877) 561-0000 to speak with a Medicare fraud lawyer today.