A detailed insight into the Medicare and Medicaid fraud whistleblower programs

by Brown LLC Whistleblower Law Firm,Class Actions and Injury La

Medicaid and Medicare misconducts are amongst the most common forms of fraud, costing millions of dollars every year. Since 2009, the Justice Department had recovered over $30 billion related to the False Claims Act concerning misconducts against the federal health care laws.

What is Medicaid and Medicare Fraud?

Medicaid and Medicare fraud occurs when a nursing home, hospital, or a healthcare clinic bills the state or federal government for services and supplies that were actually never offered. Medicare misconducts are unbridled and they often cost the taxpayers billions a year. They also affect susceptible populations who depend on Medicare to get major treatments.

Types of Medicaid and Medicare misconducts

Medicaid and Medicare misconducts could take a variety of forms, including:


Upcoding takes place when a nursing home, hospital, or a private healthcare clinic bills Medicare or Medicaid for services and supplies that are costlier than the services actually offered or performed.


Overbilling for healthcare services or medication happens when a hospital, nursing home, or a private doctor’s clinic bills Medicare or Medicaid inflated costs for services and medications or bills for services or medications it never provided. For instance, a patient undergoes a surgery and receives a bill with the inclusion of charges for the surgery, surgical tools, and even the tray used during the procedure. This would make an ideal case of overbilling.


The anti-kickback statute is to prohibit paying, receiving, soliciting, or offering anything of value that could possibly reward or induce referrals for services or items paid for by the healthcare providers. For instance, a chemist company might try to ensure doctors prescribe only their company’s drugs by offering them trips, payments, or anything of value.

Superfluous medical procedures

A doctor might order superfluous medical procedures where they have ordered expensive treatment which is not medically indispensable. Procedures might be superfluous if they are unusual in the treatment of the patient with a specific condition; in case a procedure is performed more often than required; or if a treatment is performed which is prohibitively expensive than an optional treatment that could have attained the similar results. Unnecessary treatments, expensive surgeries might account for as much as 20% of operations in some specialties, such as spinal surgeries, and certain cardiac procedures.

Medicare and Medicaid fraud attorneys at Brown, LLC have had helped clients in cases ranging from long-term care misconducts, DRG false claims, coding false claims, outpatient APC false claims, Medicare kickback violations, Stark law to PPS false claims. Medicare has been expanded and amended several times since it got introduced in 1965. Although efforts have been put to mitigate Medicare misconduct, it still has a long way to go. Medicare misconducts have been costing taxpayers millions of dollars and using the qui tam programs of the False Claims Act, a major portion gets returned to the government.

The abolition of third-party payments straight to the healthcare providers in preference to reimbursement of the beneficiary would help; however, there will still be many cracks. Medicare and Medicaid fraud can only be disclosed by Medicare fraud whistleblowers. And, it is also imperative that the False Claims Act’s Qui Tam continues to be obtainable as an encouragement for Medicare fraud whistleblowers to report.

For years, Medicare and Medicaid fraud whistleblower program have brought substantial returns to the government. Many of such Medicare and Medicaid fraud claims and the consequent returns had been made possible by courageous whistleblowers coming forward to report these frauds. Using Qui Tam programs under the False Claims Act, these people have been able to prevent misconduct and also have collectively been awarded millions for their part in bringing the frauds to justice.

Brown, LLC, led by a former FBI Special Agent, is one of the most prestigious Medicare fraud whistleblower law firms in the USA. If you are confused about whether to come forward and report on a Medicare fraud, consult our Medicare fraud whistleblower attorney immediately. We will help you reach a satisfactory decision. Call us for a free confidential consultation at (877)-561-0000.

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Created on Jul 7th 2021 13:49. Viewed 610 times.


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