Medicare and Medicaid Fraud

How to Collect a Reward for Reporting Medicare Fraud

If you work for a hospital, pharmacy or other healthcare organization that is submitting false claims to Medicare or Medicaid, you may be eligible to receive a financial reward for reporting the fraudulent activity. By coming forward with your information, not only can you help save taxpayer dollars, but you may also be entitled to a reward of 15 – 30 percent of the total amount recovered by the government through a False Claims Act lawsuit

Common Medicare Fraud Schemes

Phantom Billing – It is against the law for hospitals, doctors’ offices and other healthcare organizations to bill Medicare or Medicaid for services not provided, perform and submit invoices for unnecessary procedures, and double-bill for services.

Improper Substitution of Generic Drugs – Medicare fraud is occurring if a pharmacy charges Medicare for brand name drugs, but provides customers with less expensive, generic drugs.

Pharmacy Benefit Manager Fraud – In recent years, there has been an increase in whistleblower cases involving pharmacy benefit manager fraud. Some of these lawsuits were filed against pharmacy benefit managers that retained the proceeds of drug company rebates, rather than pass these discounts along to Medicare and Medicaid customers. In addition, Medicare fraud may be occurring if a pharmaceutical benefits manager is reselling potentially unsafe drugs that have been returned by mail-order customers.

Upcoding and Unbundling Fraud – Under Medicare and Medicaid, hospitals and other healthcare organizations are required to use specific billing codes when submitting claims for payment for medical services provided. Upcoding occurs when a healthcare provider fraudulently uses a higher-paying code than the code that should be used for the service that was rendered. Unbundling occurs when a hospital or other healthcare organization bills Medicare or Medicaid separately for related medical procedures that should be billed under a single billing code. Both upcoding and unbundling are illegal.

Aware of Medicare Fraud? Want to Learn More?

Anyone with knowledge of Medicare fraud, such as doctors, nurses, or claims administrators, may be able to receive a substantial financial reward for reporting fraud against the government. For more information and a free individual case review, fill out the form on this page.