Medicare and Medicaid Fraud
Serving Clients Nationwide
The Medicare system represents a huge portion of government expenditure, and the work involved in simply processing claims and paying providers leaves few resources available for verifying the validity of those claims. Medicare simply pays the claims without much investigation into potential fraud and abuse. As a result, Medicare fraud is rampant nationwide, costing taxpayers billions of dollars in Medicare funds.
With limited funds available to investigate Medicare fraud, the federal and state governments rely on whistleblowers to report fraudulent activity. The qui tam provisions of the False Claims Act provide generous incentives and strong protections for whistleblowers who file qui tam lawsuits on the government’s behalf.
Types of Medicare Fraud
Nearly every part of the healthcare industry provides opportunities for unscrupulous persons and entities to defraud Medicare. Under the False Claims Act, any claim for Medicare payment that is tainted by any illegal activity or noncompliance with established regulations could potentially be considered Medicare fraud. Types of action that usually constitute fraud include:
- Billing Medicare for any good or service that is not medically necessary
- Billing Medicare 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
- Stark Statute violations
While not all inaccurate Medicare billing necessarily involves intentional fraud, healthcare providers and manufacturers of drugs and medical equipment must diligently adhere to all applicable regulations to avoid potential False Claims Act violations. However, many players in the healthcare industry continue to submit false or fraudulent Medicare claims hoping to avoid detection. Medicare fraud is not just stealing from the government, in many cases it also represents a public safety risk as healthcare providers who act out of their financial self-interest rather than in the best interest of patients may provide substandard or even unsafe treatment.
Becoming a Whistleblower on Medicare Fraud
Lacking the resources to ferret out all instances of Medicare fraud, the responsibility to address Medicare fraud falls on individuals of conscience with the courage to report fraudulent activity using the qui tam provisions of the False Claims Act. Whistleblowers are a crucial asset to our nation’s efforts to reduce the rapid escalation of healthcare costs nationwide, much of which is the result of fraud and abuse of the Medicare system. Therefore, the law affords significant whistleblower protection to those who come forward in qui tam actions as well as lucrative whistleblower rewards.
The qui tam attorneys at Kenney & McCafferty have detailed knowledge and more than a decade of experience in qui tam law, having represented whistleblowers in high-profile cases nationwide. If you have knowledge of any type of Medicare fraud, Kenney & McCafferty has the resources and experience to handle your case and help you maximize your whistleblower reward.
If you have knowledge of a fraud or false claim against the government, please contact our qui tam lawyers today. Kenney & McCafferty attorneys will consult with you about your case, without obligation. All communications with Kenney & McCafferty attorneys during these consultation services are confidential and protected by the attorney-client privilege.
