It is thought that tens of billions of dollars a year or about ten percent of all healthcare spending in the USA results from the submission of false claims to government healthcare programs such as Medicaid and Medicare and each year through the False Claims Act and a skilled whistleblower attorney, billions of dollars are recovered. Whistleblowers improve the system, hold entities accountable, and can receive whistleblower awards up to 30% of the government recovery. With roughly $3 billion a year recovered, that’s close to a billion dollars a year for whistleblowers.
Since its creation in 1966, Medicare has become one of the largest benefits programs in the United States and with it every year Medicare Fraud has skyrocketed. Nearly 20 percent of the US population is currently covered by Medicare. The Medicare program is financed by federal funds from taxes and premiums paid by program beneficiaries. The Medicare program depends on the physicians and other healthcare professionals to exercise judgment in the best interest of the patients. Admissions and services given to a patient that lack medical necessity is not in the best interest of the patients as it can harm them, and can be considered as fraud.
Medicare pays claims based upon a bare electronic submission indicating that a particular medication or service was provided to the patient. The government has no well-defined procedure for due diligence in clearing the bill beyond computer edits. Therefore, significant opportunities exist for fraud in such a large system and that opportunity is exploited. Truth is that up to 10% of all Medicare and Medicaid costs are fraudulent, costing the US taxpayers billions of dollars each year.
The Stark Law and Medicare Fraud
As one of the top whistleblower law firms in the U.S., Brown LLC’s Medicare whistleblower lawyers have extensive expertise in prosecuting a variety of frauds including Part D fraud, average sales price (ASP), upcoding and unbundling, CPT/HCPCS miscoding, anti-kickback and Stark Law, disproportionate share hospital (DSH), lab and pathology, unnecessary services and supplies, and many more Medicare Fraud and Medicaid Fraud violations.
The Stark Law prohibits physicians from benefitting from their referrals without full disclosure. So a Doctor can’t refer a patient to a clinic he or she owns without disclosing the interest to that clinic, since there is a self-interest and an appearance of a conflict, if not, an actual conflict. Otherexamples of Stark Law violations include overpaid medical directorships, improper discounts and illegal recruitment arrangements that may result in a financial windfall for the physician.
No matter how small or large the Medicare fraud is, the federal False Claims Act (FCA) provides the whistleblowers a pathway to report fraud safely. If you blow the whistle correctly and “under seal” for through an experienced Medicare whistleblower lawyer, you stand a chance to obtain a whistleblower award. Under seal means your identity will be kept secret until the government completes its investigation, which could sometimes take years.
If you have knowledge of Medicare or Medicaid fraud happening at your workplace or former job, you can be a whistleblower and file a qui tam or whistleblower case.
However, to successfully file a qui tam lawsuit, you must satisfy the below four criteria:
Blow the whistle the right way
Although it may be tempting to report the fraud directly to the government, it may destroy your chance of earning an award as more important than reporting the case is the way how you blow the whistle. A Medicare whistleblower lawyer can help you with keeping a detailed record of the fraud, and also guide you with the correct legal procedure to file a successful qui tam claim and maximize your chances of recovery.
Evaluating the information for a qui tam claim
Based on your information, Brown LLC’s Medicare whistleblower lawyer will determine whether your qui tam falls within the actionable requirements under the law to file a case in the first place. The first whistleblower coming forward with new and useful information is only allowed to receive the reward. If you have substantial insider information about the fraud that qualifies for a qui tam claim, the Medicare whistleblower lawyer will advise you to act fast as a whistleblower lawsuit must be filed within six years of the date of fraud or within three years once the government becomes aware of it, plus if you’re not the first to file you may lose your case down the line.
Maximizing your chances of cash benefits for you
The top whistleblower law firm Brown LLC and its lawyers has obtained hundreds of millions of dollars in recoveries in the litigation it participated in over the year . As a qui tam relator, you can reap of up to 30 percent of total recoveries plus litigation costs by hiring the best Medicare whistleblower lawyers. The qui tam law firm operates nationwide. Its whistleblower protection lawyers protect you and your job and wield the damages provisions of the relevant laws to maximize the cash rewards for the clients who are courageous enough to blow the whistle on fraud against the government healthcare programs.
Under the False Claims Act, it is illegal for the employer to demote, harass, dismiss a whistleblower or their family. Whistleblower protection lawyers will educate you on your rights and file additional whistleblower protection lawsuits to ensure that you are protected from retaliation and retribution by your employer. Brown LLC’s whistleblower protection lawyers have helped clients in a variety of cases ranging from billing for services not rendered, illegal kickbacks, pharmaceutical fraud, upcoding, and many other types of Medicare frauds.
Factors to Consider Before Blowing the Whistle and Why You Must Consult with Whistleblower Attorney
The most experienced whistleblower attorneys at Brown, LLC are going to answer the most frequently asked questions in this article. There are many individuals with the knowledge of potential Medicare fraud, who seek answers to these following questions before they take it to government officials.
AMLA Create Whistleblower Protection Program with Substantial Award for Blowing the Whistle on Fraud
Whistleblower cases must be based on facts, mere speculation is not enough to file a claim. The best Medicaid whistleblower lawyer at Brown LLC, the top whistleblower law firm, will help protect your rights as a whistleblower and ensure that your case is successful. Ask questions to your counsel if you don’t understand a procedure and follow their expert advice as closely as possible.
How to Report a Suspected Medicare Fraud Anonymously and Increase Your Chances of the Whistleblower
There are many healthcare industry incidents that can be viewed as fraud by law enforcement agencies. All stakeholders, be it patients, medical professionals or contractors, can get involved in fraudulent activities.
