Medicaid Medicare Systemic Fraud: Who’s Affected?

Medicare fraud report lawsuit settlements can be filed by employees.

Are you an employee who currently works or previously worked for a healthcare facility that you suspect to be complicit in systemic Medicaid and/or Medicare fraud?

Are you a defense contractor paid by the Federal Government with knowledge about systemic fraud against the government occurring at your place of employment?

If you’ve answered “Yes” to either of the above questions, you may be eligible to become a whistleblower into the fraudulent medical billing of the government by filing a Medicare fraud report that may result in a class action lawsuit.

Last year billions were recovered, and as a whistleblower, you may receive an award up to 30% of what the government recovers for having the courage to expose the corruption. Your identity can be concealed for a long period of time as well as the case progresses.

Government healthcare programs provide important benefits to a huge number of Americans. However, the size of these programs lead to oversight challenges and leave programs like Medicaid and Medicaid vulnerable to fraud.

The U.S. Government Accountability Office (GAO) has designated both Medicare and Medicaid as “high risk” for fraud. A number of laws have been passed to offer strident protections for individuals who blow the whistle on Medicare fraud and Medicaid fraud.

Illinois and California also offer protections and whistleblower awards for individuals who blow the whistle on systemic private insurance fraud.

The qualified attorneys working with Top Class Actions are looking into filing class action lawsuits that resulted from Medicaid and Medicare fraud reports and whistleblowers to help you receive the compensation you deserve.

What Can I Do?

Do you work in a healthcare setting or for a pharmaceutical company that has engaged in fraudulent medical billing or other types of potential systemic Medicare or Medicaid fraud?

If so, you may be eligible to file a Medicare fraud lawsuit against the wrongdoer and help the government recover the losses it experienced due to the fraud.

Some Medicare fraud whistleblowers have been awarded tens of millions of dollars for their role in uncovering the fraud. You may also be entitled to a significant portion of the award if your case is successful.

You may qualify to become a whistleblower under the following circumstances:

  • You are aware of institutional and systemic fraud ONLY. This investigation is not for individual claims of fraud unless you are a California or Illinois resident.
  • You were an employee at the institution/facility responsible for fraud. This investigation is not for patients. 
  • The fraud which you are reporting occurred in the last 6 years.

If you qualify, an attorney will contact you for a FREE case evaluation.

What Is Medicare and Medicaid Fraud?

When a medical provider makes a fraudulent medical claim for Medicare or Medicaid, they have engaged in Medicare or Medicaid fraud.

The federal False Claims Act permits a Medicaid or Medicare fraud whistleblower to sue on behalf of the federal government about fraudulent billing or other fraud. The Act states that “Private citizens who successfully bring qui tam actions may receive a portion of the government’s recovery.”

Illinois and California have also enacted similar laws that permit whistleblower claims for fraudulent medical billing of insurance companies.

There are numerous ways in which a medical provider or pharmaceutical company can engage in fraud against federal government programs, including:

  • Submitting a claim for services not rendered
  • Inflating cost reports
  • Submitting a claim for a service, treatment or test that was never rendered
  • Falsifying research data to secure a grant
  • Improper kickbacks
  • Submitting a claim for a service, treatment or test that is more expensive than the one actually performed
  • Refusing to care for high-needs patients
  • Bundling and unbundling packages for procedures typically performed together
  • Falsifying documents
  • Submitting claims for medically unnecessary treatments
  • Improper financial interests
  • Improper pricing or marketing of drugs

“Fraudulent conduct can drive up consumer costs, undermine competition, and in some cases, even put people’s lives at risk,” Deputy Associate Attorney General Stephen Cox said in a January 2020 statement. “By effectively enforcing the False Claims Act, we protect the taxpayer, we deter bad actors, we protect victims and we level the playing field in the marketplace.”

Read more: What is Medicare Fraud?

What is the Penalty for Medicare Fraud?

A person or entity found to have committed Medicaid or Medicare fraud may be liable for three times the amount that the government was defrauded, plus civil penalties ranging from $5,000 to $10,000 for each false claim made.

If you work for a healthcare provider or pharmaceutical company that has engaged in fraudulent medical billing, you may qualify to file a whistleblower lawsuit on behalf of the government to help recover the money lost due to the fraud. If the case is successful, you could also be entitled to significant compensation.

Have Fraudulent Billing Lawsuits Been Filed?

A Medicare fraud lawsuit was recently unsealed by the U.S. Department of Justice. The complaint accuses Cigna of overbilling for its Medicare Advantage plans by submitting unsupported diagnoses that allegedly resulted in billions of dollars in overpayments.

The whistleblower in the Medicare fraud lawsuit was a former officer for Texas Health Management, a company that reportedly worked with Cigna-Healthspring from 2012 to 2017.

According to the Medicare fraud lawsuit, the company reportedly sent nurses and nurse practitioners to conduct a health assessment at patients’ homes. These assessments were then allegedly improperly submitted to the Centers for Medicare and Medicaid Services.

Under Cigna’s assessment program, these nurses and nurse practitioners were sent to patients’ homes. They were expected to see 35 patients per week and generate at least 20 diagnoses per visit.

The Medicare fraud lawsuit describes this program as “a data-gathering exercise used to improperly record lucrative diagnoses to fraudulently raise risk cores and increase payments from CMS.”

In another lawsuit, three whistleblowers were awarded $3 million for exposing Medicare fraud at skilled nursing facilities in California. In that case, the whistleblowers said that Longwood Management Corporation pressured rehabilitation therapy specialists to bill at the highest level of Medicare reimbursement.

Longwood and its affiliates agreed to pay $16.7 million to settle the Medicare fraud lawsuits.

Read more: Cigna Whistleblower Lawsuit Alleges $1.4 Billion in Medicare Fraud

How Can a Medicare Fraud Lawyer Help You?

Lawyers are currently looking for whistleblowers who can disclose instances of fraudulent billing or other types of Medicare fraud or Medicaid fraud by healthcare facilities such as physician’s offices, hospitals, surgery centers, treatment facilities, and pharmaceutical companies.

A successful Medicare fraud lawsuit can result in significant compensation for speaking out against the fraudulent billing. In some cases, courts have awarded millions of dollars to whistleblowers who stepped up to report Medicare fraud.

Whistleblowers who file a Medicare fraud lawsuit may be able to receive between 15 and 30% of the total judgment or settlement, or potentially 50% under certain state laws. This award is only available if the government recovers money from the wrongdoer as a result of the Medicare lawsuit. Simply informing the government about alleged Medicare fraud is not sufficient unless you properly and confidentially file the whistleblower lawsuit under seal with a whistleblower attorney.

Read more: How Does Medicare Fraud Whistleblower Protection Work?

Are You Ready to Be a Medicare/Medicaid Fraud Whistleblower? Learn Your Rights.

Systemic Medicare and Medicaid fraud defy the core mission of providing aid and support to those who are medically suffering and rips off the taxpayers. Perpetrators who deliberately exploit the vulnerability of patients and potential patients must be held accountable.

A Medicare fraud lawyer can help you decide if filing a lawsuit is the right step for you to take. A lawyer can help you gather all of the necessary evidence to secretly file the whistleblower action under seal in Court.

A Medicare fraud report lawsuit is not only an effective way to hold the defendant accountable for wrongdoing, it can also return the ill-gotten money to the taxpayers. If the case is successful, you may also be entitled to a significant amount of compensation.

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 and file a Medicare fraud report. 

Fill out the form on this page now for a free case review. 

Get Help – It’s Free

Free Medicare Medicaid Whistleblower Evaluation

Fill out the form below for a free case evaluation. If you qualify, a lawyer will contact you to discuss the details of your potential case at no charge to you.

  • The law firm responsible for the content of this page is: Brown, LLC
  • Please note that this investigation is for institutional and systemic fraud ONLY, and is NOT for suspicions regarding an individual improperly receiving benefits. The only exception is for residents of Illinois and California, who may submit regarding private insurance fraud.
  • This investigation is for employees, NOT patients. If you do not/ have not worked for a listed facility, you may not qualify for this investigation.
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