You Can Be Compensated for Reporting Medicare/Medicaid Fraud

Medicare Attorney in San Antonio

Do you think a health care provider is submitting inflated invoices to the government? Maybe you are a billing clerk, administrator, nurse, or doctor who knows fraud is being committed by a health care provider. Or maybe you are a patient or family member who believes that the hospital, nursing home, rehabilitation facility, pharmacy, or other health care provider has submitted fraudulent bills to Medicare, Medicaid, or other government health insurance. At Brylak Law, we can screen a patient’s bills for errors or inflation free of charge. If we find proof of fraud, we could potentially begin a qui tam lawsuit.

Medicare fraud results in billions of dollars in losses every year with increased costs passed on to millions of Americans. By blowing the whistle on these perpetrators, you can help reduce fraud and obtain compensation for your efforts. Our Medicare attorney in San Antonio can help you pursue the issue, maximizing your chances of obtaining compensation while minimizing the risks that you will be retaliated against.

Types of Fraudulent Medicare Practices

Both individuals and businesses can commit Medicare fraud.  Here are some typical examples:

  • A provider may bill Medicare for services or supplies that the patient never received.
  • A hospital may obtain interim payments from Medicare throughout the year, and then file a false cost report at the end of the year to avoid making a refund to the Medicare program.
  • A hospital includes a pap smear in the bill for every visit, including those for men.
  • A business may provide a consumer with false information to induce him or her to sign up for a Medicare program the consumer otherwise wouldn’t have.
  • An individual may use another person’s Medicare information to receive services and benefits from the covered person’s plan.
  • A company may offer a non-approved drug plan, claiming it is covered by Medicare when it is not.

Compensation and Protection for Medicaid/Medicare Fraud Whistleblowers

The federal False Claims Act authorizes individuals with firsthand knowledge of fraud against the government to bring a lawsuit for damages on the government’s behalf, and to share in the recovery. These types of whistleblower actions are called “qui tam” actions and the person bringing the lawsuit is called a “qui tam relator.”

The Process

The process of a qui tam lawsuit can be a long one. According to the False Claims Act, you can sue an person or business that is committing Medicare/Medicaid fraud. Your suit will then be filed “under seal,” which ensures confidentiality from the accused while the government further investigates the case. While the government rarely joins in on a qui tam lawsuit, its participation can certainly help your case. The False Claims Act then seals the case for 60 days (and this can be extended). If the government wishes, it can partially lift the seal on the qui tam lawsuit to discuss the investigation and a potential settlement with the accused party. These settlement negotiations are usually the favored result of a qui tam lawsuit rather than an extended court trial. The settlement amount for the lawsuit varies according to the level of investigation in the case. If the government is involved in the case and the case results in compensation, you (the whistleblower) are can receive 15 to 25 percent of the funds. However, if the government does not decide to participate in the case, you receive 25 to 30 of the recovery funds.

As a relator, you may share in a percentage of the proceeds from any award or settlement of the case. Depending on various factors – including the type of case, whether or not the government “intervenes” (participates as a plaintiff) in the lawsuit, and the extent to which you contribute to the prosecution of the action – you can receive up to 30 percent of the amount recovered by the government in a False Claims Act lawsuit. Since the perpetrator of the fraud could be liable for triple damages and hefty fines, the compensation can be substantial. You need not have been personally harmed by the defendant’s conduct.

Federal law also protects you if you are discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in employment as a result of bringing a case under the False Claims Act.  This protection includes reinstatement, double back pay plus interest, and other damages incurred as a result of the discrimination.

Contact a Medicare Lawyer in San Antonio

Since the costs of Medicaid/Medicare fraud are passed on to everyone, stopping helps reduce costs while also increasing the quality of care.  If you suspect Medicare/Medicaid fraud and would like more information about your rights to report the fraud and receive compensation, please call us.  We will evaluate your claim and advise you whether it merits pursuing. If you are a patient who has noticed irregularities or suspicious items on your Medicare bill, bring us your full itemized bill.  We can perform an audit free of charge to investigate whether fraud is involved. For help from a Medicare lawyer in San Antonio, contact Brylak Law today at 866.883.5533