Health Care Fraud

Health Care Fraud – What is it?

Health care fraud, or medical fraud, is a despicable crime that not only rips off taxpayers, but steals from the pockets of America’s poorest and most helpless citizens. These schemes allow giant corporations, health care conglomerates, and even individual doctors to get rich while billing the government for services they should be providing to patients.

This kind of health care fraud is also specifically called Medicare fraud and Medicaid fraud because those are the government health care programs most often targeted. The government has even set up a Medicare Fraud Strike Force and a Health Care Fraud Prevention and Enforcement Action Team (HEAT) to try to uncover fraud like overbilling, false billing, off-label marketing and kickback schemes.

While the scammers get rich, patients either receive improper care, insufficient care, no care at all, or are subjected to drugs, tests and treatments they don’t even need – all so these criminals can bill the government for reimbursements under Medicare, Medicaid, TRICARE and other programs funded by taxpayers. That’s right; they pick your pocket to fatten their own purse.

Health care fraud steals money the government needs to provide medical services to America’s needy – the poor, the elderly, and children – putting them in danger of losing access to health care.

I’ve witnessed health care fraud at my job. What should I do?

You may be in the miserable position of witnessing health care fraud at your job. Maybe you have to file paperwork that you know is incorrect or deliberately falsified. Perhaps you’re responsible for creating a paper trail for an “educational seminar” that allows your company to pay doctors to send them patient referrals. You know what the company is doing is wrong. What should you do?

Well, the unfortunate truth is that if you know there’s fraud and you’re not reporting it, you could be implicated in the crime. But proceed with caution.

Before you do anything else, talk to a lawyer. There is a contact form right here on this website. A lawyer will be able to provide you with a CONFIDENTIAL conversation about your options. There are laws in place to protect whistleblowers, which is what you are. You are “blowing the whistle” to bring attention to the fraud.

Whistleblowers are absolutely essential to stopping health care fraud. The qui tam provisions of the False Claims Act allow employees to become the “eyes and ears” of the federal government to uncover health care fraud. Health care fraud most commonly occurs inside pharmaceutical companies, hospitals, clinics and health care service providers.

In many cases, whistleblowers also are eligible for a reward as a result of exposing fraud. If the government gets involved in your case, and is successful in bringing the wrongdoers to justice, you can share in the money they recover.

Whistleblower rewards are usually between 15 and 25 percent of what the government recovers. In fact, the U.S. Justice Department is reporting record recoveries as a result of Medicaid and Medicare whistleblowers. Here are just a few examples:

  • Alabama nurse receives $15 million whistleblower reward for exposing Medicare Fraud – In this case, a nurse filed a False Claims Act lawsuit against a nursing home after witnessing the company falsely billing the government for services it didn’t provide, or that it administered to patients unnecessarily.
    Read More…
  • U.S., Georgia Hospital Settle Whistleblower Medicare Fraud Case for $8 million – The whistleblower will receive $2.16 million for her role in exposing the fraud at a long-term acute care hospital and helping the government recover vital Medicare funds.
    Read More…
  • 243 Professionals Charged in Record Medicare Fraud Crackdown – This is being touted as the “largest criminal health care fraud takedown in the history of the Department of Justice.” The Medicare and Medicaid fraud scheme cost U.S. taxpayers $712 million.
    Read More…
  • Whistleblower lawsuit alleges massive Hospice and Medicare Fraud Scheme – The criminals involved in this enterprise were fraudulently billing taxpayers for hospice services that were not needed. That meant hundreds of non-terminally ill patients were convinced to stop seeking treatment so the hospice company could fraudulently bill Medicare to the tune of $67.5 million for hospice services.
    Read More…