Sage Datko  |  September 23, 2020

Category: Legal News

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In 2019, the federal government was able to recover approximately $2.6 billion from cases of healthcare fraud. If you work in healthcare and believe you have evidence of your company engaging in Medicare or Medicaid fraud, you may be able to file a whistleblower lawsuit against them on behalf of the government.

What Is Medicaid Fraud and Abuse?

Medicaid and Medicare fraud and abuse may occur in many ways. Often, this abuse is committed by physicians, pharmacists, or other healthcare providers.

One common form of Medicaid abuse is billing Medicare or Medicaid, which are government sponsored health insurance programs, for services that weren’t actually provided to patients. This may look like upcoding, or billing for services that are more expensive than the services that were actually performed, or it may look like the physician billing for services that were unnecessary and did not need to be performed.

Another form of Medicaid fraud is unbundling, or billing separately for services that are usually charged at a discounted package rate. The profit gained from billing in this way may be pocketed by the fraudulent physician.

Medicaid abuse may also include providing benefits to patients who are not eligible to receive them. This may occur by incorrectly reporting the income or assets of the patient, or by making deceptive or false claims about the patient in order for Medicare to determine them to be eligible to receive services. This type of abuse may go hand in hand with instances of fraud where the physician files a claim for reimbursement despite not being entitled to reimbursement for the services provided.

Finally, a common form of Medicaid fraud occurs when physicians conspire to refer patients to each other. When these schemes are engaged in by physicians, patients may be unnecessarily referred to other physicians or specialists. However, instead of being referred to these doctors out of medical necessity, the patients may be passed around in order to provide multiple physicians the opportunity to bill Medicare for unnecessary services. Physicians who engage in these schemes may be hurting both the government and patients, by ordering unnecessary or intrusive testing incentivized by profits rather than by a desire to help the patient.

What Is the Penalty for Medicaid Fraud?

Prison Time Handed Down in Medicare Fraud ProsecutionPhysicians who commit Medicare fraud may be subject to financial penalties or legal action.  Civil medicaid fraud penalties may include fines of up to three times the amount of the actual damages, plus additional penalties of up to approximately $11,000 for each fraudulent claim. Those who commit Medicaid fraud may also be subject to potential criminal charges. Even if there is no specific intent to commit fraud, physicians who commit fraud due to deliberate ignorance or reckless actions may still be subject to fines or legal action.

How Can Citizens Fight Medicaid Fraud?

If you work for a healthcare company, you may be uniquely positioned to prevent cases of Medicaid fraud. Employees who believe that their company may be committing fraud against the government may be eligible to file a whistleblower lawsuit if they have unique evidence that has not yet been reported.

Whistleblowers may be entitled to receive a portion of any money that the government is able to recover due to their information. This compensation is generally between 15 and 25 percent of any recoveries. Additionally, whistleblower protection laws prohibit companies from retaliating against current or former employees who blow the whistle and expose instances of fraud.

Under whistleblower protection laws, employers are prohibited from firing, laying off, reducing the hours of, or refusing to promote workers who report instances of fraud. Employers are also prohibited from disciplining, harassing, intimidating, or threatening these workers. These prohibitions extend beyond the worker’s time with the company, as employers are also prohibited from blacklisting the employee or interfering with their ability to obtain employment in the future.

In 2019, approximately $2.6 billion was recovered through lawsuits regarding healthcare fraud. Many of these lawsuits were filed by current or former employees who had first hand knowledge of the fraudulent claims that were being submitted.

Can You File a Medicaid Fraud Whistleblower Lawsuit?

If you have new and unreported evidence that your employer may be violating the False Claims Act or other laws related to Medicare and Medicaid fraud, you may be able to speak with an experienced attorney about your legal options. People who file whistleblower lawsuits may be entitled to a percentage of any recoveries due to their information, and they should also be covered by anti-retaliation whistleblower protection laws.

Free Medicare/Medicaid Fraud Whistleblower Evaluation

If you are aware of instances of systemic Medicare and/or Medicaid fraud within your place of employment — specifically healthcare facilities like hospitals, doctor’s offices, treatment centers, pharmaceutical companies, and more— take action today. 

Get a Free Case Evaluation

This article is not legal advice. It is presented
for informational purposes only.

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