How to Report Medicare Fraud

Medicare fraud costs American taxpayers anywhere from $17-57 billion each year and that figure keeps rising. The government’s healthcare fraud prevention and enforcement efforts recovered a record $4.2 billion in taxpayer dollars in 2012 and nearly $4.1 billion 2011. The funds were recovered from people and companies who attempted to defraud federal healthcare programs that are set up to serve senior citizens and low income individuals or from those who sought payments to which they were not entitled. There are no truly “accurate” figures showing how much Medicare fraud ultimately costs the nation, since many acts of fraud are not caught. The federal government must generally rely on private citizens to step forward and report his or her employer.

Coming Forward with Information of Fraud

Those who come forward to report first-hand knowledge of Medicare fraud are known as “whistleblowers”. It requires both courage and a great sense of right and wrong for employees to report Medicare fraud. Most whistleblowers understand that committing Medicare fraud hurts not only the American taxpayers, but the very programs that were set up to assist sick beneficiaries. If your employer is participating in acts of fraud against the government sponsored insurance provider, it is vital to understand how to report Medicare fraud.

Reporting Your Employer on Your Own

Once you have decided to come forward with information concerning Medicare fraud, there are different methods of reporting your employer. The first is by providing an anonymous tip. The problem with anonymous tips is that your information will be placed on a long list of various complaints placed by citizens each day. In addition, there is a good chance your information may never be reviewed due to leaving incomplete details or information about the fraud.

The second method of reporting your employer is to contact your local FBI office and speak directly to an agent working in the Medicare Fraud and Abuse Department. The problem with this method is that, again, you may be among hundreds of other people who have provided tips and information.

Pursuing a False Claims Act Lawsuit

The third method of reporting Medicare fraud is by pursuing a False Claims Act lawsuit. The False Claims Act is a federal piece of legislation that encourages whistleblowers to come forward and report fraud through providing financial incentives. For whistleblowers who bring successful False Claims Act suits, the financial rewards are anywhere from 15 to 30 percent of what the government ultimately recovers from the provider. A whistleblower, or qui tam, lawsuit allows those who report fraud to get rewarded for the professional and personal risks taken to expose and stop fraud against the government.

In order to report Medicare fraud under the False Claims Act, you must employ an attorney who specializes in the practice of qui tam lawsuits. Under the qui tam provisions of the False Claims Act, private citizens with first-hand knowledge of governmental fraud are allowed to file lawsuits on behalf of the United States.

After consulting with an experienced False Claims Act attorney, a qui tam lawsuit will be filed against your employer. The qui tam suit is filed under seal, protecting your anonymity and preserving the integrity of a Medicare fraud investigation. The suit remains under seal for the duration of the investigation, after which point the government will decide whether or not it will intervene.

How Does a False Claims Act Attorney Help When Reporting Medicare Fraud?

There are many advantages to using an experienced and successful False Claims Act law firm when reporting Medicare fraud. Medical and healthcare law can be extremely detailed and complex. In order for your case to be successful, it may require the experience and knowledge of a lawyer who specializes in qui tam.

Another benefit is the potential working relationships an experienced False Claims Act attorney has previously established with the government. When the government chooses to intervene in a qui tam whistleblower lawsuit filed under the False Claims Act, it drastically increases the chances of a successful outcome.

For more detailed information about reporting Medicare fraud, the False Claims Act and qui tam lawsuits, contact the Law Offices of Berger and Montague at (215) 875-5712.

 

By | 2018-06-07T11:04:37+00:00 June 7th, 2013|Healthcare Fraud|