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Federal Whistleblower Lawyers Blog - Medicare Fraud

Federal Whistleblower Lawyers Blog - Report Medicare or Medicaid Fraud

Qui Tam Lawyers Providing Diligent Representation to Employees Nationwide

At the Whistleblower Law Firm, we have the knowledge and skills to represent you if you witnessed Medicare or Medicaid fraud. Our whistleblower attorneys help individuals nationwide hold hospitals, physicians, and other healthcare providers accountable for fraudulent and illegal billing practices. We work closely with legal professionals in other states, as well as with federal and state agencies, to expose improper Medicare and Medicaid activity.

Medicare & Medicaid Fraud

Medicare and Medicaid are government-sponsored health insurance programs that provide coverage to millions of Americans. In 2013, over 52 million people were enrolled in Medicare, and nearly 72 million were enrolled in Medicaid. With such a vast number of participants, it is difficult for the government to identify all incidents of fraudulent claims made by healthcare providers. According to a 2013 study by the U.S. Government Accountability Office, the Medicaid program alone paid out more than $431 billion in 2013. An estimated $14.4 billion (nearly 6 percent) of this amount consisted of improper payments.

While most healthcare providers bill Medicare and Medicaid programs for the services and devices they actually provide, others engage in unlawful and wasteful practices. Examples of fraud include:

  • Billing for services that were never provided to a patient;
  • Billing for unnecessary medical services, treatment, or equipment;
  • Upcoding, or billing for a more serious and expensive diagnosis or procedure;
  • Unbundling, or billing separately for a group of procedures commonly billed together; and
  • Billing for services under someone else’s Medicare or Medicaid number.

If you are aware of fraudulent Medicare or Medicaid activity, you can bring a suit under federal or state law. Our attorneys can investigate and prepare your claim and take action to protect your rights.

The False Claims Act

While the government has made efforts to identify and prosecute these unlawful activities, it also relies on individuals to come forward and report incidents of Medicare and Medicaid fraud. It offers incentives to encourage exposure while also protecting the rights of whistleblowers.

If you have witnessed Medicare or Medicaid fraud, you can file an action under the False Claims Act (FCA). This federal law imposes liability on anyone who knowingly submits an inaccurate statement or record to induce the government to pay a claim. The FCA also gives individuals the right to file an action on behalf of the government for violations of its rules. This is known as a qui tam lawsuit, which is submitted to the court under seal. The Department of Justice has 60 days to decide whether or not to proceed with the claim. Depending on whether or not the government intervenes in the matter, you may receive between 15 and 30 percent of any money recovered from the defendant if the action is successful. If you are exposing unlawful conduct by your own employer, the FCA also provides protection against any retaliatory action, such as demotion or termination. Many states have similar laws that encourage whistleblowers to come forward to report any incidents of fraudulent activity.

A qui tam action under the FCA must be filed within six years from the date of the violation. A claim may also be filed if it is within three years from when material facts should have reasonably become known. A qui tam action, however, cannot be filed in any circumstances if it has been more than 10 years since the violation.

Seek Assistance from Qui Tam Attorneys Available Nationwide

We represent individuals in qui tam and similar claims nationwide. Our lawyers have substantial experience taking action against medical and healthcare providers. If you have witnessed Medicare or Medicaid fraud, we can use our more than 200 years of combined experience to help you hold an entity accountable for its misconduct. We represent individuals in areas such as Chicago, Georgia, and Michigan, among many others. Call our office at (800) 982-1904 or contact us through our online form to schedule a confidential consultation.