If you have witnessed Medicare and Medicaid fraud at your place of employment, you may be able to file a qui tam, or whistleblower lawsuitagainst your employer on behalf of the government. Whistleblowers who file lawsuits on behalf of the government are protected by the qui tam provision of the False Claims Act.

Medicare and Medicaid Fraud Overview

Medicare and Medicaid fraud may take several forms, including phantom billing, patient billing, or upcoding and unbundling.

In phantom billing fraud, the medical provider bills Medicare or Medicaid for procedures that either are never performed or are unnecessary. Medical procedures, tests, or equipment may all be billed for under this type of scam. In some cases, equipment that is purchased used or at a discount may be billed to Medicare or Medicaid at the price of new equipment.

Patient billing fraud sometimes involves a patient who is part of a scam. These patients provide their Medicare or Medicaid identification number to a medical provider in exchange for kickbacks or money. The medical provider uses this identification number to bill Medicare for procedures or tests, and the patient is instructed to confirm the treatment if asked by Medicare or Medicaid.

Another type of fraudulent scheme commonly used to defraud Medicare or Medicaid is upcoding or unbundling. In these schemes, medical providers inflate their bills to government programs by using billing codes indicating that the patient is in need of a more expensive procedure than the procedure that is actually performed. This scheme relies on billing for procedures that cost more than the procedure that was actually performed or billing for individual items, procedures, or tests that are commonly bundled together under one code or price.

These schemes harm the government by stealing money from Medicare and Medicaid that could be allotted to other patients. Medicare fraud endangers the health and lives of patients, as well as being unethical and illegal.

False Claims Act Overview

The False Claims Act is meant to protect the government from being defrauded by companies or individuals providing services. In addition to outlining penalties for companies or individuals who submit false or fraudulent claims for payment, the Act also provides rights and protections to individuals who report on their employers for fraudulent behavior. Whistleblowers who report on their employers are protected from harassment, as well as from being fired or demoted.

Lawsuits and Settlements

Whistleblowers
who file lawsuits under the False Claims Act on behalf of the government are entitled to a percentage of any recovered financial damages. However, whistleblowers may only file these lawsuits if they are the first to do so. If a lawsuit has already been filed against your employer concerning Medicare or Medicaid fraud, you will be unable to file another lawsuit unless you have unique evidence.

How Can An Attorney Help?

Hiring a qualified and experienced qui tam attorney to represent you in your whistleblower lawsuit may increase your chances of winning the case, as well as ensuring that you take advantage of the rights afforded to you under the False Claims Act. Many attorneys work with whistleblowers on a contingency basis, meaning that they are only paid if you win your case.

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