Whistleblowing in Medicare Fraud Cases

When an employee reports the illegal conduct of their employer, they become a whistleblower. Whistleblowers have exposed corporate practices that were not only unethical but actually, put people’s lives at risk. Even when a company is committing acts that are clearly wrongful, employees who discover that their employers are committing crimes are faced with difficult decisions. One issue they likely face is the possibility of suffering from retaliation, such as being terminated, if they decide to expose the illegal conduct.

However, it is often the case that only an employee would be in the position to learn the information necessary to report their employer’s wrongful actions. Whistleblower protection laws help to encourage people to speak up when employers commit illegal acts and to discourage employers from retaliating against employees who choose to do the right thing. One area where whistleblowers are extremely important is in the healthcare industry, where programs such as Medicare are frequently defrauded.

Medicare fraud

Medical facilities such as hospitals and nursing homes sometimes overbill Medicare. As it turns out, Medicare fraud accounts for around 10% of the total payments made by Medicare. In dollars, this means that the Medicare program if fraudulently billed tens of billions of dollars a year.

Medicare fraud often includes scenarios where medical facilities bill for services or equipment that they did not provide, or bill for a more expensive treatment than was actually given to the patient. There are some situations where patients covered by Medicare take part in the fraudulent acts, permitting the provider to use their Medicare number to bill for procedures or services that they did not actually require.

Because Medicare is designed to pay doctors quickly and therefore encourage them to see patients who are on Medicare, the program automatically pays out for claims that are filed, making fraud detection difficult. This has made Medicare particularly vulnerable to fraud.

The staggering costs that result from Medicare fraud are highly disturbing. But fortunately, some employees of medical facilities make the brave decision to speak out thereby exposing their employers’ illegal actions.

What protections exist for an employee who reports Medicare fraud?

In many cases, healthcare providers and other people working for medical facilities are the people best positioned to discover fraudulent billing practices. Of course, these people’s jobs might be threatened by their willingness to come forward and report the fraud.

In order to discourage Medicare fraud, perpetrators are subjected to heavy fines for their actions. Whistleblowers are awarded a portion of the fine paid by the violating facility, as well as a portion of the money recovered. This can lead to high reward payouts to whistleblowers. Additionally, though, retaliation against a whistleblower in a Medicare fraud claim is prohibited by law.

If you believe that your employer is committing Medicare fraud, you should speak with an experienced attorney. In some cases, it is possible to receive an award and have your job protected when you decide to do the right thing and report Medicare fraud.   For further information, contact the seasoned Mississippi Qui Tam Attorney at Barrett Law, PLLC today.



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