Medicare Whistleblower Case | Healthcare Fraud

If you’re thinking of filing a Medicare whistleblower case, you’re not alone. Every year, billions of dollars (yes, that’s billions with a B) are spent on false medical claims. Whether the source is inadequate care, illegal kickbacks, or overcharging for goods and services, the scope of fraud is frankly astronomical. In fact, one government audit estimated as much as 10% of Medicare charges are fraudulent!Medicare Whistleblower Case

Common Types of Medicare Fraud

In case you are wondering what qualifies as “fraudulent,” here is a list of some of the most common forms you might come across in any medical practice:

Double Billing: Billing for the same service more than once.
Fake/Phantom Charges: Charging for services that were never performed.
Up Charging: Billing for expensive equipment and testing when inferior items were actually used.
Co-payment Comps: Rolling required co-pays into the bill under false charging categories.
Kickbacks: Receiving a benefit from a company or lab in exchange for using them exclusively, or more than others.

And the list goes on and on. Every year, people find new ways to attempt to defraud the Medicare program. The government must rely on good citizens to turn in the fraudsters, blowing the whistle on illegal activities. This is the heart of the False Claims Act.

Filing a Whistleblower Suit…Or Not

Once you become aware of any fraudulent activity against the government, the first thing you should do is stay quiet and hire a lawyer. Be sure to do some research, and interview a few firms. This is incredibly important as your lawyer will be a vital part of your success, and determining the size of reward you may be eligible to receive.

Once your attorney has reviewed the case, they can advise you on the best course of action. In some instances, it may be in your best interest NOT to file suit. Your lawyer should explain the possible outcomes, ramifications, and the likelihood of success so you can make an educated decision.

If you do decide to proceed, you will be filing as a private citizen acting in the interest of the government, to recover funds on their behalf. You may or may not need to cover attorney fees accumulated up to this point; be sure and ask about the billing and settlement process during the interview phase.

Government Review of Medicare Fraud Suits

Your lawsuit will be filed in secret (AKA “under seal”), and only you, your attorney, and the government will be aware it exists. The government has this opportunity to review all the facts, findings, and proof contained in your supporting documents. Based on the strength of the case, the government then chooses whether or not to join your case, or intervene.

Government Intervention for Whistleblower Lawsuits

If the government joins, they take over pursuit of the case, working with your lawyer to hand it off to their attorneys. This is a good thing, as cases where the government intervenes have a much higher success rate. Your payout is then determined at the end of the trial, and most of your attorney fees are likely covered through the payout.

If the government doesn’t intervene, then you have to choose whether to push forward or not. Your share of the payout will be higher if you succeed, but if the lawsuit fails, you may be liable for all your attorney fees.