Medicare & Medicaid Fraud

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Medicare & Medicaid Fraud

Washington, D.C. Whistleblower Attorneys

Medicare, Medicaid, TRICARE, and other government healthcare programs account for a significant portion of federal spending every year. As healthcare costs continue to rise, the time and resources that are consumed just by processing claims and making payments leave very little available for verifying even a small number of claims.

Because of this, Medicare and Medicaid are forced to simply pay submitted claims without investigating them for abuse or fraud. This has led to serious Medicare and Medicaid fraud nationwide, costing taxpayers billions of dollars at a time when federal funds are most needed.

Since such a minimal amount of resources are available for investigating these claims, the government depends on private parties to report any fraud and abuse they become privy to. If you have any knowledge of fraudulent Medicare, Medicaid or TRICARE claims that have been submitted to the government, you can file a qui tam lawsuit under the False Claims Act. Since you are suing on behalf of the government, this law not only provides you with generous monetary incentives to file, but also legal protection from retaliation.

Common Types of Medicare Fraud

Both Medicare and Medicaid pay for goods and services in almost every area of the healthcare industry, making the entire healthcare sector vulnerable to fraud. According to the False Claims Act, if a medical provider is involved in any type of illegal activity, or if they are not in compliance with federal regulations, then any payment the provider receives from Medicaid, Medicare, or TRICARE can potentially qualify as a false claim.

Some examples of actions considered Medicare fraud include:

  • Billing for a good or service that is not deemed medically necessary
  • Billing for services not rendered, or billing for services more complex and expensive than those rendered (referred to as “upcoding”)
  • Non-compliance with the FDA’s regulations for suppliers of healthcare products, including pharmaceuticals, medical devices, and medical equipment
  • Improper documentation of medical necessity or other information
  • Any violation of the Anti-Kickback Statute

While inaccurate billing is not always intentional, all healthcare providers are expected to be thorough as they strive to comply with appropriate government regulations. Nevertheless, many medical manufacturers and vendors simply hope that their fraudulent actions will go unnoticed.

Exposing Medicare Fraud as a Whistleblower

Since the government lacks the necessary resources to effectively investigate Medicare and Medicaid claims, it relies on conscientious individuals who have the courage to report fraud under the False Claims Act. Medicare and Medicaid whistleblowers play a vital role in nationwide efforts to reduce the growing cost of healthcare in the United States. If a healthcare vendor’s fraudulent claims have resulted in injury or illness to a patient, you may also be able to recover damages for medical malpractice.

If you have specific information about Medicare fraud committed against the government, the experienced qui tam attorneys at Chaikin, Sherman, Cammarata & Siegel, P.C. can help you investigate the situation without compromising the case or your own legal status. Contact us today to schedule a confidential case evaluation.

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