Medicare fraud tricks the government out of billions of dollars each year.

Health care providers sometimes submit fraudulent billing to Medicare for services that may not have been clinically necessary, or that may have never been actually performed.

The federal government runs its own investigation and prosecution of Medicare fraud, but it can’t always catch every case. That’s where whistleblowers come in. Private citizens with sufficient evidence of Medicare fraud can supplement government enforcement by bringing their own whistleblower lawsuit.

One of the biggest cases of Medicare fraud ever was stopped last year. In June 2015, U.S. Attorney General Loretta Lynch announced arrests were being made in connection with $712 million stolen from Medicare. In all, 243 people were arrested and charged, 46 of whom were medical professionals.

The arrestees were charged with various fraudulent practices used to bilk money out of the Medicare program. A group of arrestees from Texas were accused of coaching patients to trick their doctors into prescribing them medications they didn’t actually need. Some facilities were accused of billing Medicare for therapy sessions that never actually took place.

One doctor was purportedly responsible for $23 million in losses after he allegedly prescribed a thousand motorized wheelchairs that weren’t medically necessary.

Another doctor allegedly offered patients prescriptions for addictive drugs in exchange for those patients’ identification information. The information was then used to create false billings for Medicare. Patients who became addicted to the drugs were unwittingly bound to the scheme, the government alleged.

Stopping Medicare Fraud With A Whistleblower Lawsuit

In these cases, the U.S. Department of Justice was able to investigate and, with enough evidence, press criminal charges. But taking legal action against Medicare fraud isn’t exclusively in the government’s hands. Private citizens with first-hand evidence of fraud against the government can bring a whistleblower lawsuit on the government’s behalf.

Medicare fraud whistleblower lawsuits, also known as “qui tam” lawsuits, are governed by the federal False Claims Act. This law gives private citizens a way to stop Medicare fraud that may have otherwise gone unprosecuted.

In each such action, the government gets a chance to investigate the allegations and, if it finds the claim is worth prosecuting, take over the whistleblower’s job of litigating the action, or “intervene.” The whistleblower stays involved in the case, though. If the government is successful in prosecuting the Medicare fraud, the whistleblower will be entitled to a share of however much money is recovered – usually 15 to 25 percent of the total recovery.

The DOJ’s announcement from 2015 revealed some extraordinary methods of Medicare fraud. Some more common practices that could be grounds for a whistleblower claim include charging Medicare patients more for the same drugs, paying kickbacks to providers for prescribing certain drugs, or misrepresenting services performed in order to increase the reimbursement to the provider.

Persons who think they may have witnessed Medicare fraud can get a full picture of their legal options by speaking with a knowledgeable Medicare fraud attorney.