Medicare Whistleblower Reward

Along with Social Security, Medicare is the largest entitlement program in the United States and is responsible for spending billions of taxpayer dollars every year. It is, therefore, little wonder that Medicare is frequently the target of healthcare fraud and false claims made by healthcare practitioners, contractors, and others. By some estimates, government programs pay out $100 billion annually in false claims, constituting a severe blow to the integrity of Medicare and the trust of taxpayers.

The federal government works hard to stop this Medicaid fraud but can only do so much considering its limited budget and staff. To reduce waste, the government enlists whistleblowers reporting fraud that enables investigators to act against illegal and unethical activity. That’s where the whistleblower law firm of Oberheiden P.C. comes in. If you have evidence that someone is ripping off Medicare, we can help you not only put an end to the abuse but claim Medicare whistleblower rewards for doing so.

The Many Forms of Medicare Fraud

You may work for a hospital, drug company, or other business in the healthcare industry that deals regularly with Medicare. You could become a whistleblower if you have evidence of fraud, false claims, or illegal or unethical behavior. Some examples of such misconduct include:

• Billing fraud: This is a major area of abuse and involves a number of bad faith practices such as billing for goods never rendered or services never provided. Some hospitals and doctors also bill for medically unnecessary items or procedures, and even some that do not exist.
• Upcoding: This term refers to a healthcare provider who submits codes to Medicare, Medicaid, or private insurers for more serious (and therefore more expensive) diagnoses or procedures than were actually made or carried out. It is a deliberate attempt to get more money from Medicare than should be paid.
• Unbundling: Many procedures are often performed together and billed as a single unit, such as incisions and closures incidental to surgery. Unbundling, also known as fragmentation, is the illegal act of billing for bundled services separately to increase the amount that Medicare pays out.
• Off-label pharmaceutical fraud: Some pharmaceutical representatives illegally market drugs for purposes that are not FDA-approved. This enables pharmacies to bill Medicare when government healthcare programs would not otherwise pay for the drug.
• Kickbacks: A form of bribery, kickbacks happen when anything of value is exchanged for the referral of a patient or the use of medical products. These frequently appear on patient bills as designated health services, the cost of which is reimbursed through Medicare.
• Drug diversion: Drug diversion is a conspiracy to divert drugs from legitimate medical uses to the black market. Costs are billed to Medicare but the drugs never make their way to patients, and instead end up in the hands of individuals and groups who should not have these controlled substances.
• Collusion and conspiracy: Medicare fraud often doesn’t involve just one bad actor, but several. Providers, pharmacies, and healthcare businesses may all conspire together to commit fraud and submit false claims to the government.

How Can I Become a Whistleblower?

The first thing to know about being a Medicare fraud whistleblower is that the evidence you have does not need to conclusively prove fraud. It is rare that a single individual will possess the so-called “smoking gun” that is sufficient to send fraudulent parties to jail. However, you also need to have more than a hunch or vague suspicion to report healthcare fraud. Retaining experienced whistleblower counsel can help you determine the value of your information, a crucial component that will come in later to have the Medicare whistleblower rewards paid.

Generally, the information you have to report Medicare fraud must be original. This means it is not already known to the government or the general public. The information can either aid an existing government investigation or allow the government to open a new one. In other words, your evidence may contribute to an ongoing fraud inquiry and still be eligible for a whistleblower reward.

We help you become a whistleblower by filing what is known as a qui tam lawsuit pursuant to the False Claims Act. A qui tam lawsuit is filed on behalf of the government with the intention of not only stopping committing Medicare fraud but reclaiming funds that were misspent by Medicare. The Federal False Claims Act is a federal law that makes it illegal to defraud the federal government by submitting false claims like those described above.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester

Former U.S. Attorney

Hon. Kevin McCarthy

55th Speaker, U.S. House of Representatives (ret.)

Government Consultant

Mike Pompeo

Of Counsel

Former U.S. Secretary of State

John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara

Federal Appeals Attorney

Nicholas B. Johnson

Former Prosecutor

Roger Bach

Former Special Agent (DOJ)

Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen

Former Supervisory Special Agent (FBI)

How Much of a Reward Can I Claim?

This depends largely on two factors: how much the government is able to recover because of the information provided by the whistleblower and whether the government intervenes in False Claims Act cases.

The more valuable your information is, the higher the chances are that the government will be able to recover a substantial sum of money from the defrauding party. The Department of Justice and U.S. Attorney’s Office may decide (or be required) to investigate the evidence that the whistleblower submits. Upon an exhaustive review of this information, the government may decide to intervene in the matter and pursue the individuals or entities committing fraud.

If the government intervenes and recovers funds that were defrauded from Medicare, the whistleblower can recover between 15% and 25% of this money. This includes not only a percentage of the actual damages, but treble (or triple) the damages and civil monetary penalties if the case goes to court. Meanwhile, if the government declines to intervene, the percentage bumps up to between 25% and 30%. Considering the vast sums of money that are defrauded from Medicare, these percentages can translate to significant rewards.

Contact Our Medicare Whistleblower Rewards Attorney

Oberheiden P.C. can represent you by evaluating your information, filing all required court paperwork, litigating the qui tam case on your behalf, and making a compelling argument to the government for the highest reward available. Find out why so many whistleblowers trust our dedicated legal practice. Give us a call today, or reach out using our online contact form, to schedule your confidential consultation.