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Medicare and Medicaid Fraud
Washington, DC Qui Tam Attorneys
Healthcare programs like Medicare, Medicaid, and TRICARE account for an enormous portion of federal spending, and healthcare costs continue to rise each year. In addition, the time and resources consumed simply by processing claims and making payments to providers leave very little available to verify even a small portion of the claims. Medicare and Medicaid are forced to just pay submitted claims without investigating those claims for fraud or abuse. As a result, Medicare and Medicaid fraud are serious problems nationwide and cost taxpayers billions of dollars at a time when federal funds are scarce.
Because so few resources are available for investigating Medicare and Medicaid claims, the government depends on whistleblowers to report fraud and abuse. If you have knowledge of fraudulent Medicare, Medicaid, or TRICARE claims submitted to the government, the False Claims Act allows you to file a qui tam lawsuit on behalf of the government. This law also provides you with generous whistleblower incentives and thorough legal protection from retaliation. Chaikin, Sherman, Cammarata & Siegel, P.C. represents whistleblowers nationwide who report Medicare or Medicaid fraud under the False Claims Act.
Types of Medicare Fraud
Almost every area of the healthcare sector is vulnerable to Medicare and Medicaid fraud because these programs pay for goods and services throughout the healthcare industry. According to the False Claims Act, if a healthcare provider is engaged in any illegal activity or is not in compliance with federal regulations, any payment the provider receives from Medicare, Medicare, or TRICARE may potentially qualify as a false claim. Actions that are normally considered Medicare fraud include:
- Billing for any good or service that is not medically necessary
- Billing in a way that does not accurately represent the goods or services provided, such as upcoding or billing for services not rendered
- Noncompliance with FDA regulations for suppliers of pharmaceuticals, medical devices or equipment, and other healthcare products
- Improper or noncompliant documentation of medical necessity and other information
- Violations of the Anti-Kickback Statute
Inaccurate billing to Medicare, Medicaid and TRICARE does not always constitute intentional fraud, but all healthcare providers as well as pharmaceutical and medical device manufacturers are expected to be thorough in their efforts to comply with all appropriate regulations. Nonetheless, many manufacturers and purchasers simply hope that their fraudulent claims will not be investigated.
Medicare and Medicaid fraud are not simply financial crimes. Healthcare fraud is also a significant risk to patient safety when healthcare providers put profits ahead of patients’ best interests, leading to unnecessary, substandard, or unsafe medical treatment.
Becoming a Whistleblower on Medicare Fraud
Without the necessary resources to investigate Medicare and Medicaid claims, the federal government relies on people of conscience who have the courage to become whistleblowers and report Medicare fraud under the False Claims Act. Medicare and Medicaid fraud whistleblowers are especially important in efforts nationwide to reduce the rapidly rising cost of healthcare in the United States.
For this reason, the False Claims Act offers crucial protection for whistleblowers as well as generous whistleblower rewards for successful qui tam claims, which can reach into the millions of dollars. The qui tam attorneys of Chaikin, Sherman, Cammarata & Siegel, P.C. are ready to help you organize your qui tam claim if you have knowledge of Medicare or Medicaid fraud of any kind. We will dedicate our efforts toward maximizing your whistleblower reward while ensuring that you are completely protected from retaliation under the False Claims Act.
If you are aware of any type of Medicare or Medicaid fraud or false claims against the US government, please contact our qui tam lawyers today. Our attorneys will offer legal consultation without obligation. All communication between you and Chaikin, Sherman, Cammarata & Siegel, P.C. attorneys during the consultation process are completely confidential and are protected by attorney-client privilege.
