While Medicare does not have an official estimate as to the amount of money loss to fraud each year, the Federal Bureau of Investigations estimates that fraud occurs in three to ten percent of all health care billings. Each year, Medicare expenditures exceed $560 billion. Applying the FBI percentages to this amount, the cost of Medicare fraud annually can be estimated at somewhere between $17 and $57 billion.
What is Medicare fraud?
Medicare fraud is defined as the collection of Medicare health care funds based on fraudulent actions. There are several types of Medicare fraud, but all have the same ultimate goal—to illegitimately collect funds from the Medicare program sponsored by the U.S. government. Some types of Medicare fraud include:
- Patient billing: A patient participating in the scam provides his or her Medicare number in exchange for kickbacks. The provider then bills Medicare for whatever services and the patient is instructed to report he or she did receive the alleged medical treatment.
- Phantom billing: A medical provider bills Medicare for procedures or tests that were never performed or were unnecessary, or for unnecessary equipment or equipment that is used but billed as new.
- Unbundling and Upcoding: When the medical provider or someone else associated with billing inflates bills by using billing codes that indicate more expensive procedures were performed.
How are Medicare whistleblower cases brought?
If you are an employee and you suspect Medicare fraud is occurring in your workplace, you can bring a claim under the False Claims Act. This suit is known as a qui tam action. The suit is essentially brought by you, the whistleblower, on behalf of the government.
What can I expect to receive under the False Claims Act?
Those that are found to have violated the False Claims Act will be liable for three times the amount of funds that the government has been defrauded. A whistleblower who brings the Medicare fraud action can expect a reward of between 15 and 30 percent of the total recovery awarded to the government.
Is my job at stake for bringing a whistleblower action?
The False Claims Act protects employees who bring a qui tam lawsuit and experience retaliation from their employer because of their whistleblowing actions. If a whistleblower is fired, threatened, demoted, harassed, or otherwise discriminated against his or her employer due to the qui tam action, the employee will be protected. Reinstatement may be granted or back pay and damages, depending upon the employer’s actions and employee’s wishes.
Barrett Law PLLC: Mississippi Whistleblower Attorneys Assisting Clients with Medicare Fraud Reporting Actions
Medicare fraud is a tremendous problem in the U.S., costing the government and taxpayers billions of dollars each year. With the costs of healthcare rising and the population of the U.S. continuing to age, it is becoming more and more important that individuals like you speak out about suspected Medicare fraud. Medicare fraud actions are typically brought under the False Claims Act, which allows the whistleblower to recover a portion of the funds recovered by the government in the action. This can be significant and all whistleblowers must ensure their rights are protected. The Mississippi Whistleblower Attorneys at Barrett Law PLLC have assisted numerous Medicare fraud whistleblowers across the state and much of the southeast since 1936. Our attorneys will strive to see that your rights are fully protected and you receive the compensation you deserve for bringing the action. To find out more about your potential whistleblower action, call Barrett Law PLLC today at 1 (800) 707-9577 to schedule your free consultation.