Whistleblowers who report Medicare fraud through a Medicare fraud hotline may not realize they won’t get whistleblower employment protection or the potentially larger awards that come with filing a full whistleblower lawsuit.

Medicare fraud hotlines have been established to help concerned witnesses blow the whistle on Medicare fraud. These hotlines give employees of health care providers an easy and anonymous way to report fraud.

However, anonymity may be the only protection from employer retaliation that a Medicare fraud hotline can offer – and it might not always be enough.

It’s possible for a caller to blow the whistle via a hotline and still lose their job for doing it, even if their report leads to a successful prosecution of an authentic case of Medicare fraud.

Whistleblower Protection Under the False Claims Act

To get legal protection against retaliation, a whistleblower needs to file a whistleblower lawsuit.

In cases alleging Medicare fraud, these claims are governed by the False Claims Act. This law allows individuals to take action against persons or businesses who may be cheating the U.S. government via a federal program or contract.

Many people who have evidence of such fraud are employees of the businesses perpetrating it. So, the Act provides legal protection for such employees who take the risk of blowing the whistle.

The False Claims Act can provide relief for any employee who is discharged, demoted, harassed, or otherwise discriminated against because of lawful steps they took in furtherance of a whistleblower action.

These employees may be entitled to reinstatement in case of termination, double back pay, and compensation for other special damages, including attorneys’ fees and costs of litigation.

Successful whistleblowers get a cut of the recovery. A whistleblower whose claim leads either to a judgment or settlement can get anywhere from 15 to 30 percent of the amount of money recovered.

Callers to a Medicare fraud hotline can’t necessarily expect a similar payout.

Common Medicare Fraud Hotline Calls

The calls made to Medicare fraud hotlines reveal certain patterns in the way some providers try to get away with Medicare fraud.

One frequent method of defrauding Medicare is to bill for services or supplies that were never actually provided. Sometimes the patient receives the incorrect statement showing the false billing. In those cases, the patient typically points it out to the care provider and never reports it to Medicare.

Some providers engage in what’s known as “up-coding”: billing for a test or procedure that’s a little (or a lot) more expensive than the one that was actually performed.

Similarly, when a procedure performed is not one that Medicare covers, the provider may bill Medicare for a different procedure, one that the system does cover.

Alternatively, a provider may report a diagnosis that’s different from what the patient actually has, in an attempt to justify treatment that Medicare would not consider absolutely medically necessary.

When Should I Seek Legal Advice?

For those who’ve already called the Medicare fraud hotline, it may still not be too late to file a whistleblower lawsuit. Knowledgeable whistleblower attorneys are available to discuss a claimant’s situation on a case-by-case basis.