What Types Of Medicare Frauds Are Reportable By Medicare Whistleblowers In The United States?

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

Fraud in the Medicare and Medicaid space is quite prevalent, and it substantially adds to the rise of Medicare costs. Unfortunately, this is pervasive, especially at the time of national and global health crisis. The governments, be it federal or state, collectively invest billions of dollars on Medicare as well as Medicaid, however, it is the tax paying public that suffers at the hands of medical malpractice.

Whistleblowers have been playing vital role in preventing Medicare fraud

Many reports suggest that about 10% of all Medicare spending is the outcome of false claims and this eventually amounts to billions annually, in false billing to Medicare and Medicaid. Whistleblowers who bring Medicare fraud case under the State False Claims Act or Federal False Claims Act may receive substantial monetary awards. Whistleblowers award programs of the False Claims Act identify the substantial role whistleblowers play to save the money for United States taxpayers, while making sure of the integrity of the government Medicare programs.

What activities are eligible to be reported by a Medicare whistleblower?

Whistleblowers in the Medicare system need to follow certain laws and regulations; and in case they fail to follow them, knowingly or unknowingly, their reporting can be considered invalid. The most common fraudulent Medicare programs include:

Law violation that forbids kickbacks and certain financial arrangements

Posing risks to significant medical decisions through monetary gain is a crime, eligible to be reported by a whistleblower. The Stark Law and Anti-Kickbacks Statue forbid any sort of monetary arrangements that could negatively affect important medical decisions and a patient’s well-being.


Upcoding incorporates overstating the procedure, staff or time involved in the treatment to bill for longer duration and more services at a higher rate.

Risk adjustment fraud

Risk adjustment payments are quite prevalent when it comes to promoting provider support for patients with expensive illnesses. Certain examples include overstating the severity of the medical condition, fabricating claims, prescribing tests despite past diagnosis, deducing diagnosis from inadequate data and such.


Unbundling means billing one service as if it included several other services. This is considered fraudulent when the reimbursement sum for the several sub-services amounts to higher than necessary one single bundled service.

Billed for services never provided

This involves services offered by people who lack the hands-on experience or valid licenses, or services offered by interns without the minimum required experience or even supervision.

Electronic health record fraud

Many agencies that manufacture and supply EHR systems and services might face liability for developing systems that tend to fail when it comes to meeting government certification standards. Besides, hospitals and Medicare providers might also face liability for deceptively claiming Electronic Health Record incentive payments, or for giving in to false bills based on EHR systems which are purposely developed to improperly boost the reimbursements.

Brown, LLC, led by a Former FBI Special Agent, works with Medicare or Medicaid whistleblowers on the contingency basis, meaning we won’t demand any payment unless the state or federal recovers the fund and pays up the whistleblower their deserving amount of reward.

With hundreds of schemes hurting patients and Medicare providers almost every day, we urge you to become the part of solution, however under the strict guidance and support of our experienced and reputable Medicare whistleblower attorneys.

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Created on Apr 5th 2021 21:49. Viewed 493 times.


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