Medicare is a lifeline to millions of Americans. For the elderly it is often the only source of medical care, treatment, and nursing facility options. Medicare also creates jobs for thousands of doctors, nurses, technicians and other health care workers, whose livelihoods are funded by Medicare programs. The program is massive, and like many large government programs, opportunities for fraud frequently arise. The Medicare Ombudsman's Office is devoted to controlling waste and fraud, but can only do so much with limited resources. Thus the bulk of the responsibility for identifying unscrupulous medical billing practices is placed upon front line health care workers including caregivers, specialists, and medical billing and office staff.
Our nation's sick and elderly depend on everyday Americans employed in the health care industry to police waste, fraud, and corruption. Thanks to a law called The False Claims Act, honest health care workers are empowered to correct wrongful behaviors of powerful providers such as hospitals and pharmaceutical companies. Once the wrongful conduct is reported through a lawyer, the health care professional is given special “whistle-blower status” and cannot be fired for reporting the fraud. As if preserving precious Medicare resources weren't reward enough, the worker exposing the corrupt provider may share a portion of the government's recovery—potentially millions of dollars.
Vigilant health care workers have exposed numerous forms of Medicare fraud, including:
Billing brand-named drugs where generics were actually provided
Billing for phantom tests and services
Up-coding inexpensive procedures as more expensive
Up-coding nursing or intern work as doctor services Kickback schemes
For example, after bringing hospital podiatry fraud scheme to Medicare's attention, one health care worker was awarded $400,000 of the $2 million recovery. Another hospital worker reported that the hospital had received over $14 million in erroneous payments, and received a $2.1 million award for coming forward. A hospital billing employee discovered a $2 million “up coding” scheme, where his employer had billed Medicare for premium services that were never provided. He was awarded over $300,000.
If you have reason to believe your employer is defrauding Medicare, however large or small, becoming a whistle-blower is easy. Your first step is to speak with a lawyer, assured that any information you give will be held in the strictest confidence. After reviewing your case, your lawyer will help you decide if becoming a whistle blower under The False Claims Act (a qui tam relator in legalese) is right for you. Your lawyer will prepare your case, and submit it to the proper authorities for review. During every step of the process, your lawyer will make sure that your interests as well as your job are protected. Most lawyers skilled with False Claims Act cases like yours will accept your case at no charge to you, asking only for a share of the eventual settlement.
Stop losing sleep over doubts about your employer's Medicare billing practices. Talk to a lawyer experienced in Medicare False Claims Act cases who can investigate and evaluate your case, giving you an opinion as to where your employer really stands. Doing so is a blessing to vulnerable Americans who depend on Medicare, as well as a potential windfall for the whistle blower.