- The first thing you need to do as a Medicare whistleblower is hire an attorney and file a complaint under the False Claims Act (FCA). ...
- You and your attorney must be the first to report the Medicare fraud reward application. ...
- Unless you’re the original source of a scheme that’s already been made public (and you must be able to prove that you are), then you aren’t allowed to ...
- Once everything is finalized, the defendant must first pay the government the required amount to resolve the fraud allegations. ...
How do you get a whistleblower reward for Medicare 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 that is committing Medicare fraud or Medicaid fraud.
Should I talk to a Medicare whistleblower lawyer?
If you work for any provider that bills to Medicare and you are concerned about fraud issues, you should talk to an attorney who can help. The best way to know if an actual crime is being committed, and to keep yourself protected in the event of a blame-game, is to speak with an attorney who deals exclusively with whistleblower Qui Tam cases.
What is a whistleblower reward?
It is paid to the first whistleblower that properly files a whistleblower complaint under the False Claims Act. (Of course, if the defendant is committing several types of fraud, such as upcoding and kickbacks, the law allows rewards paid to separate whistleblowers for each fraud scheme.)
What is the reward for reporting Medicare fraud or Medicaid fraud?
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 report of Medicare fraud (or Medicaid fraud).
How do I get a Medicare whistleblower?
Medicare Parts A & B. By Phone. 1-800-MEDICARE. (1-800-633-4227) TTY: 1-877-486-2048.Medicare Part C. (Medicare Advantage) Varies by plan. Refer to your plan's general contact and/or fraud-reporting information.Medicare Part D. (Medicare Drug Plan) By Phone. 1-877-7SAFERX. (1-877-772-3379) OR.
Do whistleblowers get paid Medicare?
How are Medicare Whistleblower Rewards Paid? Rewards for Medicare and Medicaid fall under the False Claims Act. Those who report False Claims violations are eligible for a reward of between 15 and 30 percent of what the government obtains.
How do you get paid for whistleblowing?
Whistleblowers (known as “relators” in qui tam lawsuits) are awarded a whistleblower reward based on a percentage of the money recovered by the government when those recoveries are due to a qui tam lawsuit or claims made under the SEC, CFTC or IRS whistleblower programs.
Do you get a reward for being a whistleblower?
A whistleblower may receive an award of between 10% to 30% of the monetary sanctions collected. Since 2012, the SEC has issued more than $1 billion in awards to whistleblowers. The largest SEC whistleblower awards to date are $114 million and $110 million.
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.
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.
How much is a whistleblower award?
Whistleblower awards can range from 10 percent to 30 percent of the money collected when the monetary sanctions exceed $1 million. As set forth in the Dodd-Frank Act, the SEC protects the confidentiality of whistleblowers and does not disclose information that could reveal a whistleblower's identity.
How long does it take to get whistleblower money?
Typically, after the SEC posts the Notice of Eligibility, it takes 12-18 months for SEC whistleblowers to receive their monetary award.
What is the average settlement for whistleblower retaliation?
The mathematical average of the total recoveries (settlements and judgments) for this time period is approximately $3.3 million, with an average whistleblower award of $562,000.
Who is an eligible whistleblower?
Under the whistleblower protection legislation, an eligible whistleblower can be someone who is or was: An officer or employee of the charity. An individual or an employee of a person that supplies services or goods to the entity (including volunteers) An individual who is an associate of the entity.
What is the largest award payout to a whistleblower?
approximately $200 millionThe Commodity Futures Trading Commission awarded approximately $200 million to a single whistleblower earlier this month based on the individual's “significant contribution” to the success of a CFTC action and two Related Actions by other enforcement agencies.
What is healthcare fraud?
In its simplest form, healthcare fraud occurs when an individual or entity, like a doctor, hospital, pharmacy, home health agency, or clinic, knowi...
What can be reported as Medicare fraud?
In order to protect the integrity of the Medicare program, all suspected healthcare fraud can and should be reported to government authorities. Hea...
How do I become a Medicare fraud whistleblower?
Medicare fraud claims can be pursued under the False Claims Act (FCA), which allows anyone with knowledge of fraud against the government to bring...
How to get a whistleblower award for Medicare fraud?
In order to receive a whistleblower award for reporting Medicare fraud, you must take the following four steps: Retain a lawyer to file an FCA lawsuit against the medical practice that has committed the fraud. Your lawyer must be the first to file the whistleblower application for the fraud that you are reporting.
How to report Medicare fraud?
In order to receive a whistleblower award for reporting Medicare fraud, you must take the following four steps: 1 Retain a lawyer to file an FCA lawsuit against the medical practice that has committed the fraud 2 Your lawyer must be the first to file the whistleblower application for the fraud that you are reporting 3 The fraud must not have already been reported by the media or in other public forums unless you are the original source of the published information 4 The fraud allegations must be resolved by the defendant’s payment of money to settle the case
Why is it important to prove Medicare fraud?
Because of this, many firms have a threshold in place to make certain that the risks of the litigation do not outweigh the potential rewards.
Is Medicare fraud a whistleblower reward?
If you know that your employer is committing Medicare fraud, you should report it. When you do, you can also potentially receive a whistleblower reward.
Can you get compensation for Medicare fraud?
People who report Medicare fraud may be eligible for compensation for the help that they provide to the government. The legal team at Swartz Swidler assists whistleblowers with reporting fraud.
Does Swartz Swidler accept Medicare whistleblower cases?
The fraud allegations must be resolved by the defendant’s payment of money to settle the case. Most whistleblower attorneys, including Swartz Swidler, accept Medicare whistleblower cases on a contingency basis.
When do whistleblowers come to us?
Whistleblowers usually come to us after they have reported their concerns internally. They even call us after having already reported to agency fraud, waste, and abuse hotlines or after having spoken to the FBI or Office of the Inspector General (OIG).
What insurances are covered by the False Claims Act?
Funds can be recovered under TRICARE, CHAMPVA, the Federal Employee Health Benefits Program (FEHB), Railroad Medicare, VA programs such as TriWest, the Federal Black Lung Program, and others. These insurance plans funded by the federal government also fall under the umbrella of the False Claims Act and are subject to the same payout provisions ...
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 ...
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.
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 ...
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 Happens After I Blow the Whistle?
Initially in a qui tam lawsuit, the lawsuit is filed “under seal,” which means that only the whistleblower and the government know about it. At that point, it’s in the government’s hands.
What if the Government Does Not Intervene in My Lawsuit?
If the government chooses not to intervene in a whistleblower lawsuit, the whistleblower can choose to pursue the lawsuit by themselves, still on behalf of the government. If the whistleblower wins in this instance, they may be granted an award of up to 30 percent of what the government receives.
Are There Protections If I File a Whistleblower Lawsuit?
Under the False Claims Act, as well as state laws and the IRS and SEC statutes, there are anti-retaliation laws in place to protect whistleblowers against any negative reactions by their employer or another company. Forms of retaliation include being fired, demoted, or harassed.
Can I Pursue Whistleblower Rewards?
If you have witnessed some kind of Medicare fraud, such as a hospital or home health care company upcoding, double billing, or billing for services that were unnecessary or never provided, you may be able to pursue Medicare whistleblower rewards by filing a lawsuit on behalf of the federal government.
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.
Duty
Why someone would want to become a Medicare whistleblower can boil down to a few reasons. For one, they may feel it’s their duty. Medicare fraud not only hurts our healthcare system and the government, but it also preys on the elderly men and women in our country.
Rewards
Others may do it for the possible reward they can get from the government. Due to the strain that Medicare fraud puts on healthcare and the money it costs the government, the Department of Justice (DOJ) is more than willing to reward whistleblowers, provided said whistleblowers can prove the fraud they claim to have witnessed.
Steps Needed to Receive Rewards
Rewards aren’t given automatically, unfortunately. You have to work for it and prove the fraud you’re claiming took place. Only then can you receive a reward. If you’re the first to report the fraud, you could receive roughly 15 – 30 percent of the funds that the government recovers from the defendant.
What is Medicare fraud?
Medicare/Medicaid fraud means a medical provider – doctor, dentist, hospital, hospice care provider or nursing home – makes a fraudulent reimbursement claim. The most common types of fraud include: billing for unnecessary procedures or procedures that are never performed; for unnecessary medical tests or tests never performed; or for unnecessary equipment.
What does knowingly mean in Medicare?
Knowingly presenting (or causing to be presented) to the federal government a false or fraudulent Medicare and/or Medicaid claim for payment; Knowingly using (or causing to be used) a false record or statement to get a Medicare of Medicaid claim paid by the federal government;
What is Section 3730 H?
Under Section 3730 (h) of the False Claims Act, any employee who is discharged, demoted, harassed, or otherwise discriminated against because of lawful acts by the employee in furtherance of an action under the Act is entitled to all relief necessary to make the employee whole . Such relief may include:
What is a false claim?
Conspiring with others to get a false or fraudulent Medicare or Medicaid claim paid by the federal government; Knowingly using (or causing to be used) a false record or statement to conceal, avoid, or decrease an obligation to pay money or transmit property to the federal government.
What is a violation of the Stark Act?
Violations of various rules governing government procurement and contracting, such as the Stark Act, the Anti-Kickback Act and the Best Pricings laws. Knowingly presenting (or causing to be presented) to the federal government a false or fraudulent Medicare and/or Medicaid claim for payment.
Does Medicare fraud violate the False Claims Act?
Medicare or Medicaid Fraud violates the False Claims Act. The False Claims Act is 31 USC § 3729-3733. The qui tam provisions of the False Claims Act allow persons and entities with evidence of Medicare and/or Medicaid Fraud against federal programs or contracts to sue the wrongdoer on behalf of the United States government.