Medicare Fraud

What is Medicare?

Medicare is a government-sponsored health insurance program. It is administered by the Social Security Administration for United States citizens who are age 65 and over or for those people who suffer from a disability. The program is paid for and funded by the United States federal government.

Originally, Medicare was established with two specific costs: hospital costs and non-hospital costs. The program has evolved from its originally established position to now include additional coverage options, such as prescription drug coverage. Anyone who is covered by Medicare hospital insurance can also pay small monthly premiums to obtain additional federal medical insurance.

Both employees and employers alike contribute to Medicare by paying taxes. There is no limit on the amount of taxable income that is subject to Medicare, as Social Security tax applies to nearly every job in the country. However, as the economy has changed over the years, there has been a growing concern over the number of people who are committing Medicare fraud.

What is Medicare Fraud?

When someone commits Medicare fraud, the act can describe an individual, company or large corporation who is acting intentionally to steal money from the federal government. The most common form of Medicare fraud is called “phantom billing,” which refers to a medical provider who is billing Medicare for medically unnecessary procedures or even procedures that were never performed.

The fallout from Medicare fraud is felt by everyone. For starters, the activity hurts U.S. taxpayers, as it results in higher healthcare costs. These costs, in turn, lead to higher taxes across the board.

In addition, the very patients who desperately need Medicare services suffer due to the fraudulent activity. As more and more money is drained from the system, Medicare has no choice but to cut services and coverage for its patients.

Medicare Fraud Examples

There are reports about thousands of Medicare recipients who have been fraudulently billed for durable medical equipment, such as oxygen generators, breathing machines, air mattresses, orthopedic walkers or wheelchairs.

For instance, instead of receiving the nice, new motorized chair that the physician ordered, a patient may receive an old and dangerous model of the motorized chair due to fraud. The medical equipment provider still bills Medicare for the full price of the new motorized chair, but the patient gets stuck with something far less than what was ordered by the physician. Fraudulent Medicare schemes like these involve billions of dollars each year in bogus claims.

How to Prevent Medicare Fraud

The fight against fraudulent Medicare billing schemes is almost insurmountable for the government, as it is extremely difficult for them to detect the initial phases of the activity. By the time the federal government is aware of a fraudulent scheme, massive amounts of money have already been funneled out of the healthcare system. The sheer number of Medicare reimbursement claims that are submitted daily would make it impossible for authorities to properly scrutinize each one, looking for any indication of fraudulent billing or inconsistencies.

The U.S. government has used the federal False Claims Act to investigate a wide range of healthcare providers, from small one-physician offices, clinical laboratories and managed care organizations, to global pharmaceutical companies, nursing homes, hospital chains and home health agencies.

Report Medicare 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 a 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.

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.

Medicare Whistleblower Reward

There are financial incentives for whistleblowers within the provisions of the False Claims Act. These permit whistleblowers to share in the government’s monetary recovery. 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 be rewarded for the professional and personal risks taken to expose and stop fraud against the government.

Berger Montague’s Medicare Whistleblower Lawyers

When clients retain Berger Montague to report a Medicaid or Medicare fraud claim, the firm typically utilizes the False Claims Act to recover the fraudulently obtained funds. We understand each step in the whistleblower process and are sensitive to our client’s needs when deciding how to best collect evidence and present their claims.

We also have working relationships with the government, which are critical to increasing the likelihood that the case will be successful—when the government “intervenes” in qui tam whistleblower claims under the FCA, the vast majority of the cases are successfully resolved. In addition, we have expansive resources for research. Some cases can be very expensive and complex, and many smaller firms do not have the resources or the experience to successfully “carry” such cases.

Contact Us to Learn More

Do you need a Medicare Whistleblower Lawyer or want to know more information about Qui Tam Law and your rights under the False Claims Act?

There are three easy ways to contact our firm for a free, confidential evaluation with one of our whistleblower attorneys:

1. Fill out the contact form on this page.
2. Email [email protected]
3. Call (888) 647-9292

Your submission will be reviewed by a Berger Montague qui tam attorney and remain confidential.