Healthcare (medicare – Medicaid) Fraud
The role of the whistleblower in detecting healthcare (Medicaid and Medicare) fraud is especially important. Medicare processes over one billion fee-for-service claims per year through its contracts with regional insurance companies. Given the enormous volume of claims submitted under the Medicare and Medicaid programs, the federal and state governments are not sufficiently staffed to effectively detect the fraud and abuse perpetrated by dishonest physicians, healthcare providers and suppliers. For this reason, whistleblowers have proven to be key participants in the fight against healthcare fraud.
Although the majority of physicians, healthcare providers, and suppliers who serve people with Medicare and Medicaid bill the programs only for the services and devices they have performed or provided, others cheat the programs (and in some cases the people who are liable for co-payments) out of millions of dollars annually through fraud and other types of wasteful and abusive practices. Dishonest physicians, healthcare providers and suppliers have cost taxpayers substantial sums of money. Medicare and Medicaid lose an estimated $60 billion or more annually to fraud, making fraud on these programs one of the most profitable crimes in America. It is no surprise that since 1990, the Government Accountability Office has labeled Medicare a high-risk program. The whistleblower cases show that healthcare providers and suppliers have found many ways to defraud the government. While there are too many examples to discuss here, the list below highlights the more common types of healthcare fraud:
- Anti-Kickback Statute and Stark Law Violations
- Fraud and Other Unlawful Conduct Involving Pharmaceutical Companies
- Fraudulent Healthcare Billing
- Services Not Rendered/Add-On Services
- Upcoding and Unbundling/Fragmentation
- False Certifications and Information
- Fraudulent Cost Reports
- Grant or Program Fraud
If you have information concerning fraud on a government healthcare program, such as Medicare or Medicaid, then you may be able to bring a qui tam/whistleblower lawsuit under the False Claims Act or similar state law. Through the qui tam/whistleblower lawsuit, you can help the federal and state governments recover money that was paid as a result of fraudulent claims. As a reward for blowing the whistle, you can receive a share of the government’s recovery. A whistleblower who brings a successful qui tam lawsuit under the False Claims Act will receive between 15-30% of the amount the government recovers.
If you are considering blowing the whistle on healthcare fraud (such as Medicare or Medicaid fraud) by a healthcare provider or supplier and want to talk to an attorney about your options, contact Michael S. Bigin or Laurence Hasson.