A Florida audiologist was sentenced to nearly eight years in federal prison earlier this week for her role in a multimillion-dollar medicare fraud and money laundering scheme.

Terri S. was also ordered by Judge Steven D. Merryday to pay more than $2.5 million in restitution, the U.S. Department of Justice said in a news release.

According to evidence presented in federal court in Tampa, from about June 2010 to May 2014, Terri and her co-conspirators used three purported medical clinics to submit more than $12 million in fraudulent Medicare claims for radiology, audiology, cardiology and neurology services. Medicare paid close to $2.9 million in reimbursement on the fraudulent claims.

The evidence showed that Terri and her co-conspirators used forged and falsified documents to bill Medicare for services that had not been rendered by physicians, according to prosecutors. Co-conspirators also paid illegal kickbacks in exchange for access to Medicare patients and patient information used in the medicare fraud scheme, evidence showed.

What Constitutes Medicare Fraud?

Medicare fraud occurs when an individual, company or corporation acts to intentionally try to steal money from the federal government. This is done by submitting Medicare health care reimbursement claims, without having performed any duties.

The most common type of medicare fraud committed is referred to as “phantom billing,” which describes a medical provider billing Medicare for completely unnecessary medical procedures and even procedures the never performed. Essentially, providers overstate expenses on their Medicare claims and exaggerate the extent of the services and equipment they provide their patients with.

Whistleblower Law

Though government resources dedicated to anti-fraud enforcement are limited, whistleblowers can increase the power and impact of those resources significantly.

Individuals working in the healthcare industry are often in positions that give them inside information on medicare fraud. The government, through the federal False Claims Act, provides whistleblowers with powerful incentives to take action when they discover abuse.

Under the whistleblower law, a whistleblower may receive a significant monetary award. Additionally, the Whistleblower Protection Act serves to safeguard the whistleblower should they be wrongfully terminated or retaliated against by their employer by reporting the alleged medicare fraud.

Filing a Whistleblower Lawsuit

Fighting medicare fraud can be a very tough task for the government, because it can be difficult to initially detect the fraud. By filing a qui tam lawsuit on behalf of the U.S. government, a private citizen can help the government fight fraud.

Such actions are permitted under the federal False Claims Act. The Act encourages individuals with inside knowledge of fraudulent activity to take legal action themselves on behalf of the government.

If the government joins the action and recovers illegally obtained payments – either through a settlement or trial – the whistleblower is entitled to receive between 15 percent and 25 percent of the money recovered.

Even if the government does not join the suit, the whistleblower may proceed individually (although this is much less likely to be successful) and receive up to 30 percent of the amounts recovered.

Medicare fraud can take many forms. If you are unsure exactly what constitutes medicare fraud or if you suspect that medicare fraud is being committed against the government, please contact an experience whistleblower attorney who can answer your questions and advise you of your legal options at no charge.