Considering Blowing the Whistle on Medicare Fraud - Keep These Points in Mind

The losses due to Medicare fraud increase the overall costs of insurance for everyone and cause taxes to rise. Medicare fraud just doesn’t affect a few people or the healthcare industry alone. The rising incidents of Medicare frauds tax the entire Medicare and insurance industry. The systematic Medicare fraud schemes are incredibly dangerous that add up to billions annually. The domino effect leads to an increase in the overall cost of living for Americans as healthcare and taxes and other things become expensive to make up for the fraud. Not just financial losses, the worst part is that patients are dying as a result as they are oftentimes given improper treatment that is guided by the economic interest of the healthcare provider rather than the best interest of the patient.

Medicare fraud involves intentionally covering up the truth for obtaining illegitimate benefits. It includes performing unnecessary procedures or treatments, billing insurers for the services not rendered, misrepresenting non-covered treatments, billing each step of a procedure separately, physician-shopping to obtain multiple prescriptions, receiving kickbacks, billing a patient for more than their copay or deductible amount, etc.

The federal government spends almost $700 billion annually on Medicare program for people over 65, out of which 7% is estimated to be lost to frauds each year. In 2018, Medicare lost a colossal $2 billion to a single fraud. Over 600 defendants were charged. The multi-agency scam involving the distribution of opioids and other hazardous drugs had fraudsters across 58 federal districts. 

Convictions and penalties under Medicare fraud statutes

Over 47,000 healthcare practitioners were banned from Medicare and Medicaid programs in 2018 due to proven fraudulent activities. There were 1,503 convictions and 810 civil settlements in 2018. The lost money in Medicare and Medicaid frauds could have been used to provide quality care and other benefits to the needy persons. As of 2019, Strike Force Teams had at least 18 court cases where healthcare professionals either pleaded guilty to committing Medicare fraud, or received a sentence.

Someone, including you, have to make up for the losses due to Medicare and Medicaid fraud. This invariably adds to high premiums and out-of-pocket expenses, and also reduced coverage benefits. Legitimate healthcare workers may end up fired when an organization is taken down for fraud.

Who can be a whistleblower?

If you are an insider with information about Medicare or Medicaid fraud by your organization, healthcare facility, hospital, supplier, vendors or healthcare workers, you can blow the whistle about systematic fraud against the government. If you are an outsider, to qualify as a whistleblower you must   somehow obtain substantial and extensive information about the fraud to support your claim.

False Claims Act – the tool to fight Medicare fraud

Under the False Claims Act (FCA), whistleblower awards can be 15% to 30% under federal statute and up to 50% under state statutes of the amount recovered by the government. However, it is important to blow the whistle right away else your case may fail under FCA. For reporting Medicare fraud, care should be taken that it is filed under the seal with notice in the right way to the government. Under-seal means secretively in the court, and the defendant won’t know about it for a certain period of time. Do it the wrong way and your whistleblower lawsuit or Qui Tam claim may be over before it begins. Also, reporting Medicare fraud within the organizational structure may result in severe consequences for your case and career, as the company’s interest is to protect the company, not you.  That’s why you should hire an accomplished whistleblower law firm early in the process, who will guide you and protect you and is only paid if they win your case, so they are economically incentivized and in-line to win your case or they aren’t paid

The courts have indicated that you must use a whistleblower attorney to file a qui tam claim under FCA. So, it’s best to speak to a whistleblower law firm with some of the best whistleblower attorneys that focus in this particularized practice area.

How do I become a whistleblower?

It is also important to file the Qui Tam if you know about Medicare fraud at the earliest you become aware of it or else instead of the solution you may be considered part of the problem. You should be the first to file the case to qualify as a whistleblower and receive an award if you win the case. Even if you do everything right, someone else may have already filed a Qui Tam before you and you won’t know about it until way later in the process.

Filing your Qui Time with the help of Brown LLC’s best whistleblower lawyer will help you plead with specificity.  The law firm has the some of the best whistleblower attorneys with many millions in recoveries in Qui Tam lawsuits.  Their experienced Medicare fraud lawyers will help progress your case with the right documentation and evidence, while protecting your identity to extent and time permissible by law

Anti-retaliation protection

Brown LLC law firm is headed by a former FBI Special Agent and a team of Medicare whistleblower lawyers that specialize in the complicated area of Medicare fraud lawsuits which is not for the general practitioner. Brown LLC’s whistleblower protection lawyers will ensure that you are also counseled on how to deal with  any retribution from your employer, such as discrimination, threat, harassment, demotion, or dismissal.

The lawyers at Brown, LLC offer a free confidential consultation on whatever your whistleblower lawsuit may be about. Please contact them as soon as possible as your rights may be time sensitive, and they will make time to speak with you outside of work hours or on the weekend if it’s more convenient for you.

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Created on Feb 1st 2021 23:21. Viewed 566 times.

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