To receive a whistleblower reward, you must actually hire an attorney (which is on a contingency basis) to file a lawsuit against the hospital or healthcare provider that is committing Medicare fraud or Medicaid
Medicaid
Medicaid in the United States is a federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The Health Insurance As…
Full Answer
Can a Medicare whistleblower get a payout?
The truth is Medicare whistleblowers can wind up with a very lucrative payout. By seeking qualified representation for whistleblower law and Qui Tam Law cases, a whistleblower’s potential for a payout from the liable parties can be substantial. What Is the Whistleblower Law?
How do I file a complaint against Medicare fraud?
A copy of the complaint, with a written disclosure statement of substantially all material evidence and information of Medicare and/or Medicaid Fraud in the plaintiff's possession, must be confidentially served on the US Attorney General and the US Attorney for the district in which the complaint is brought.
What is a False Claims Act whistleblower?
The False Claims Act permits whistleblowers complaints regarding Medicare or Medicaid Fraud. These cases can be filed to anyone who directly or indirectly causes fraud in these health care programs.
How do I get a reward for reporting Medicare fraud?
The key to obtaining a reward for reporting Medicare fraud is to have proof and then report widespread fraud against Medicare or Medicaid, and not an isolated instance because the reward is based upon how much money the government collects back from the entity that is defrauding Medicare or Medicaid.
How are Medicare whistleblower rewards paid?
How are Medicaid and Medicare whistleblower rewards paid? Qui tam relators (whistleblowers) are paid directly by the government from the recoveries obtained from successful False Claims Act lawsuits.
How does the False Claims Act impact Medicare and Medicaid?
False Claims Act [31 U.S.C. Filing false claims may result in fines of up to three times the programs' loss plus $11,000 per claim filed. Under the civil FCA, each instance of an item or a service billed to Medicare or Medicaid counts as a claim, so fines can add up quickly.
How do people defraud Medicare?
Beneficiaries commit fraud when they…Let someone use their Medicare card to get medical care, supplies or equipment.Sell their Medicare number to someone who bills Medicare for services not received.Provide their Medicare number in exchange for money or a free gift.
What is considered Medicare abuse?
What Is Medicare Abuse? Abuse describes practices that may directly or indirectly result in unnecessary costs to the Medicare Program. Abuse includes any practice that does not provide patients with medically necessary services or meet professionally recognized standards of care.
What are the five elements of the False Claims Act?
The False Claims Act proscribes: (1) presenting a false claim; (2) making or using a false record or statement material to a false claim; (3) possessing property or money of the U.S. and delivering less than all of it; (4) delivering a certified receipt with intent to defraud the U.S.; (5) buying public property from a ...
What is a whistleblower suit under the False Claims Act?
The False Claims Act (FCA) allows whistleblowers to bring lawsuits against companies and individuals who defraud the federal government. Suits under the FCA and similar laws in a number of states are known as “qui tam” actions.
What are the three examples Medicare uses to describe abuse?
Common types of abuse include: Billing for unnecessary services (services that are not medically necessary) Overcharging for services or supplies. Misusing billing codes to increase reimbursement.
What is an example of healthcare abuse?
Changing or forging an order or prescription, medical record, or referral form. Selling prescription drugs or supplies obtained under healthcare benefits. Providing false information when applying for benefits or services. Using Transportation Services to do something other than going for medical services.
What is the number to call for medicaid fraud?
Call our Medicaid Hotline at 888.742.7248.
How to be a whistleblower?
As a potential whistleblower, be mindful that support staff may be asked to observe you or security police may be used to investigate you. Act as a model employee to prevent cause for disciplinary measure.
What is the job of a whistleblower lawyer?
The job of counsel is to protect your rights as a whistleblower and ensure that your case is successful. You and your lawyer are becoming partners in a process that can potentially take years. Often, your lawyer will need to ask tough questions or give advice you may not immediately understand. It can be easy to get offended or take the process to heart, however your lawyer must find and correct weaknesses in your case and needs to know the facts. Always ask questions if you don’t understand a procedure and follow your counsel’s expert advice as closely as possible to ensure the process is positive and successful.
Can a whistleblower be aware of your status?
Your company or coworkers may become aware of your whistleblower status at any moment, with or without your knowledge. Once you have decided to file a claim, it is important to seek the advice of counsel before signing any contract revisions or other documents that could have an effect on your eligibility to collect a reward.
Is whistleblower status confidential?
Depending on the type whistleblower case, your position may remain completely confidential throughout the entire process. However, it’s important to prepare for the likelihood that your whistleblower status will become known, with or without warning.
Should you discuss your whistleblower case?
There are several reasons you shouldn’t discuss your case until the time is right . Most whistleblower awards are based on first-to-file. Share your intentions with others and they may file a claim before you, eliminating your chances for a whistleblower claim.
Can you be fired for whistleblowing?
It isn’t unusual for organizations to suspect a potential whistleblower. Though you may not be fired, you may be escorted to a different position or sent on paid leave and lose access to your computer, email account and records. Keep claim-related documents and notes in a personal location.
Does your state have its own False Claims Act?
Because Medicaid is partially funded by the federal government and partially funded by the states, the amount of the relator’s share is dependent in part on whether the state at issue has its own False Claims Act.
Federal Funding and State FCAs
Further confusing matters, the amount of federal funding varies by state. In many states, the burdens of Medicaid are shared fifty-fifty, but states with higher need receive more federal funding. So, a relator in one of those states may receive a relator’s share based on 70% of the recovery, for example.
Who is the plaintiff in a Medicaid fraud case?
Lastly, all this depends on naming the states and the federal government as plaintiffs. If a whistleblower brings a state court action under just the state False Claims Act, they are likely not entitled to any amounts that are paid to the federal government.
Proceed Carefully, Hire Experienced Counsel
Making these essential determinations requires experienced False Claims Act counsel to walk the fine line between protecting your interests and your being sanctioned for pleading frivolous claims.
How to convince the government to take a Medicare fraud case?
To convince the government to take a Medicare fraud case requires detailed and specific evidence that the healthcare provider was committing fraud against Medicare or Medicaid. It is not enough to report fraud to a hotline or have a general knowledge of Medicare or Medicaid fraud. Usually, rewards are paid to whistleblowers who worked for ...
How much does the False Claims Act pay?
The False Claims Act pays whistleblowers a reward of between 15 and 25 percent of what the government collects based on your report of Medicare fraud (or Medicaid fraud). To receive a whistleblower reward, you must actually hire an attorney (which is on a contingency basis) to file a lawsuit against the hospital or healthcare provider ...
Who gets rewards for fraud?
Usually, rewards are paid to whistleblowers who worked for the hospital or healthcare provider who committed the fraud because they have knowledge of the fraud scheme, and receive a reward even if they were asked to participate in defrauding Medicare or Medicaid.
Is Medicare fraud on the rise?
Medicare fraud and Medicaid fraud is on the rise and is hurting our economy and healthcare. This website explains the process of reporting Medicare fraud or Medicaid fraud and how to receive a monetary whistleblower reward. The False Claims Act pays whistleblowers a reward of between 15 and 25 percent of what the government collects based on your ...
What is Medicare Fraud?
Medicare fraud occurs when people try to trick the government into paying for unnecessary services, or paying more for necessary care than it actually costs. While it is considered a white-collar crime, Medicare fraud can result in criminal and civil penalties, fines, and even imprisonment.
How Does Medicare Fraud Whistleblower Protection Work?
The False Claims Act includes a “qui tam provision,” which allows an individual to file a lawsuit on behalf of the federal government against anyone who has committed Medicare fraud. The government has the right to intervene and join the action, but if it declines, the Medicare fraud whistleblower can proceed alone.
Can You File a Whistleblower Retaliation Lawsuit?
Medicare fraud whistleblowers who have been retaliated against can file lawsuits to seek justice. Many have done so.
Filing a Whistleblower Retaliation Lawsuit
If you believe you have witnessed fraud by your current or former employer, you may be able to file a whistleblower lawsuit (also known as a qui tam lawsuit) against your employer on behalf of the government.
What is considered Medicare Fraud?
Knowingly submitting false statements or misrepresenting facts to get federal health care payment when an entitlement would not exist otherwise;
5 Conditions That Must Be Met according to Medicare.gov
You report your suspected Medicare fraud. The allegation must be specific, not general.
Example
For example, you didn’t participate in the fraud offense being reported. Or, there isn’t another reward that you qualify for under another government program.
What Is the Whistleblower Law?
The whistleblower law is part of the False Claims Act, which was created in 1863 to crack down on Civil War profiteering. The False Claims Act was revamped and amended by Congress in 1989, making it more accessible and rewarding for any citizen to report false claims against the government.
How Does Qui Tam Work?
The Qui Tam Law allows an individual, known as a relator, to bring a lawsuit based on claims against the False Claims Act. The citizen, with a lawyer who is knowledgeable about the False Claims Act, brings the evidence to the court and asks the court to investigate the claim.
How Are Medicare Whistleblowers Paid?
The relator- whistleblower- is paid via a system determined by the False Claims Act. It begins with the court determining the amount of the penalties owed by the provider or practice. As a part of the lawsuit, the number of violations is added up.
What Is Medicare Fraud?
According to a recent report from the Department of Justice, Medicare fraud accounts for nearly 87 percent of all money recovered as a result of whistleblower, or qui tam lawsuits brought by average citizens under the False Claims Act.
Who Are the Perpetrators?
Much of the fraud related to Medicare has been committed by pharmaceutical companies. However, while drug manufacturers are often at the top of the list, they are far from alone; other perpetrators named in fraud reporting include:
Medicare Fraud Cases
One of the largest fraud cases settled last year involved Reckitt Benckiser Group, manufacturer of Suboxone, a medication used for the treatment of opioid addiction. The company’s subsidiary, Invidior, was accused of illegally marketing the product to physicians in attempts to increase the number of prescriptions.
