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Medicare fraud occurs when healthcare providers collect reimbursement for medical services through fraud. Whistleblowers, including patients and employers, can report fraud and are protected by whistleblower laws. Medicare whistleblowers can receive rewards if the government recovers proceeds from a lawsuit. The False Claims Act also provides protection against retaliation by those who defraud Medicare.
A Medicare whistleblower is a person who reports Medicare fraud. Medicare is a federal health subsidy available to senior citizens in the United States. Medicare fraud occurs when medical institutions and health care providers collect reimbursement for medical services and treatments through fraud, including double billing, false coding, and intentionally charging for services that patients have not received. Patients and employers are often whistleblowers, and there are whistleblower laws to protect them and encourage the public to bring forward knowledge of businesses and others who are defrauding the federal government. A Medicare whistleblower attorney represents an informant in Medicare fraud cases, which are referred to as qui tam lawsuits.
Medicare is taxpayer-funded, and unexposed fraud often costs taxpayers billions of dollars each year. Some medical providers defraud Medicare because they are guaranteed a refund and cash flow. For example, hospices in the United States were caught filing Medicare claims for patients who were ineligible for benefits as a means of obtaining money to fund hospice operations. These companies often defraud Medicare because seniors may not be able to afford their services otherwise. Medicare whistleblowers who work for these companies often learn of the fraud and report it and join the government in lawsuits.
Under federal law, an individual involved in reporting fraud is eligible for a whistleblower reward if the government is able to recover the proceeds of a lawsuit or if the individual files a lawsuit. The False Claims Act outlines the rewards available and specifies that the whistleblower must be the original source leading to a successful lawsuit that exposes the fraud. The government may or may not decide to proceed with legal action. If he does, the whistleblower is often able to receive between 10 and 25 percent of the proceeds allocated to the government. The Medicare whistleblower can file a qui tam lawsuit on behalf of the government and can often recover 25 to 30 percent of what the civil court determines is reasonable in damages. The percentages also concern the eventual transaction reached before the conclusion of the process.
The False Claims Act also provides whistleblower protection against retaliatory action by those who defraud Medicare. For example, employers will be required to compensate the Medicare whistleblower if they are demoted, fired or suspended as a result of reporting the fraud. The employer would have to pay double the arrears earned by the employee, as well as special damages.
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