Medicaid & Medicare Fraud Whistleblower Reward

Medicare and Medicaid fraud and scams are serious crimes. According to the federal government, an astounding $60 billion is stolen annually through Medicare fraud. Some admit that the amount could be much more. Thankfully, if you report Medicare or Medicaid fraud, you could qualify for a Medicare fraud whistleblower reward.

This is a nationwide healthcare crisis; it is unimaginable that a healthcare provider could take advantage of the very victim they swore to serve and protect. 

When individuals make false claims to Medicare, Medicaid, and other government healthcare programs, whistleblowers can save the government billions of dollars by reporting their fraudulent actions. In exchange, the government rewards whistleblowers in amounts ranging between 15% and 30% of the amount recovered, as well as attorneys’ fees and costs. 

According to the qui tam provision in the False Claims Act, private citizens can collect such rewards when they provide the government with evidence of Medicare or Medicaid fraud. If you believe that you have a case of healthcare fraud, contact our team today if you need help attaining a Medicare or Medicaid fraud whistleblower reward.

What Is Medicare and Medicaid Fraud?

Medicare and Medicaid fraud occurs when a medical practitioner, such as a dentist, doctor, nursing home caregiver, or hospice caregiver, delivers a fraudulent reimbursement claim. 

Common forms of Medicare and Medicaid fraud may look like: billing for medical tests or procedures that were never performed or unnecessarily conducted, billing for nonessential procedures or procedures that were never performed, and billing for unwanted equipment.

Here are some other examples of Medicare and Medicaid fraud:

• Abuse in Nursing homes
• Unauthorized or illegal marketing of drugs
• Billings for services performed for ineligible candidates
• Self-dealing or improper referrals

These are just a few of the many fraudulent activities considered under the umbrella of Medicare and Medicaid Fraud. Medicaid and Medicare whistleblowers reveal classified or private healthcare information about misconduct or wrongdoing. This form of fraud violates the False Claims Act. 

These qui tam provisions allow entities or persons with proof of Medicare or Medicaid fraud against federal contracts or programs to sue the offender on behalf of the United States government. You must hire an attorney. The government can join the action or decline the action.

The False Claims Act allows whistleblower complaints involving Medicare and Medicaid Fraud; this includes indirect and direct cases of fraudulent activity in a healthcare program.

Medicaid and Medicare fraud can occur in state-administered healthcare programs. Most states have their own versions of the False Claims Act, allowing whistleblowers to recover unlawfully billed funds from State governments.

How can Whistleblowers Help Prevent Fraud?

Whistleblowers can allow justice to be served when wrongdoing or unlawful action has occurred, dissuading wrongdoers from repeating unlawful action. Those that violate the False Claims Act by committing Medicare or Medicaid fraud face civil penalties. Violators are liable for civil penalties of $5,000 to $10,000 per false claim and three times the amount the government was defrauded.

Whistleblowers who file a qui tam can expose unlawful acts and dealings that the government would have been unable to detect, bringing inside information to light. In addition, Qui tam plaintiffs may bring forward information about ongoing malfeasance or inchoate that law enforcement was unaware of.

What Are Medicare Fraud Whistleblower Rewards, and How Are They Paid? 

A qui tam plaintiff could receive between 15 and 30 percent of the full recovery from the defendant, either through a favorable settlement or judgment. Medicare and Medicaid fraud whistleblower rewards can total millions of dollars! However, the damages must be widespread, and multiple instances of fraud must be reported. 

According to most fraud lawyers, whistleblowers are often more likely to receive rewards if they have worked for a healthcare provider or hospital responsible for the fraud. This is because they have more knowledge than patients of fraud schemes and are even incentivized by rewards for participating in defrauding Medicare and Medicaid. Larger awards are paid to those with insider evidence of Medicare and Medicaid fraud.

In order to be eligible to reclaim funds under the Act, you will need to file a qui tam lawsuit. You cannot just inform the government about the fraud. You can only receive the award after the government has recovered the money from the accused because of your lawsuit.

The False Claims Act also covers employees who have been demoted, discharged, harassed, or discriminated against due to lawful acts committed by the employee in accordance with an action under the False Claims Act qualifies for any relief necessary to amend damages done. 

This relief may include the following:

• Double back pay
• Reinstatement
• Compensation for damages, including reasonable attorneys’ fees and litigation costs

One example of a large Medicare fraud case occurred in January 2020, when a Rheumatologist was convicted and found guilty of falsely diagnosing patients with long-term diseases. Then, he would treat these patients with unnecessary treatment. The court discovered that an estimated $325 million was stolen from this fraudulent healthcare scheme.