Medicare Whistleblower Lawyer
A California whistleblower attorney experienced in Medicare fraud cases can work with you to make sure your rights are protected. Filing a whistleblower lawsuit for Medicare fraud can be confusing to figure out on your own. Enlisting the assistance of a Medicare fraud attorney to file your whistleblower claim can make the legal process easier to navigate.
What is Medicare?
Medicare is a government health insurance program initiated in 1965. Medicare provides healthcare coverage for people over 65 and people with disabilities.
Medicare pays healthcare providers through a payment system based on predetermined rates. Rates can change depending on the severity of the case, where a provider is located, or other factors.
Everything a healthcare provider can bill Medicare for has a code associated with it. Providers use this code when they submit claims.
Because Medicare is a program of the federal government, a federal agency governs it. The Centers for Medicare and Medicaid Services (CMS) supervise Medicare claims and oversee payment regulations.
Verdicts and Settlements
At Cutter Law P.C., we have a long record of successfully representing whistleblowers in multiple industries. Below is a representative snapshot of the successful cases our law firm has handled:
Qui tam settlement for government fraud claims brought against Medtronic Inc., one of the world’s largest medical device manufacturers, on behalf of one of four whistleblowers.
Brooks Cutter and John Parker obtained a $4.7 million settlement of government fraud claims that our whistleblower client shared in.
$ 2.4 Million
Verdict in an intentional medical misconduct case
Settlement in a government fraud claim
What is a whistleblower?
A whistleblower exposes acts of fraud or corruption in their organization to the authorities. A whistleblower typically works within the organization they’re reporting on and has firsthand knowledge of the fraudulent activity.
The False Claims Act and Whistleblowers
A federal agency (CMS) oversees Medicare, so any incidents of a healthcare facility defrauding Medicare can fall under the False Claims Act. The False Claims Act was established as a result of defense contractors making fraudulent claims to get more money during the Civil War.
Today, the False Claims Act is a federal provision that allows the government to collect compensation (plus damages) when someone knowingly files false claims to defraud the government. Under the False Claims Act, a whistleblower can also bring a lawsuit on behalf of the government and receive compensation.
Filing a Qui Tam Lawsuit
As a whistleblower, you can file a qui tam lawsuit in response to the defrauding of a government agency. A qui tam lawsuit allows an individual to initiate legal action against another party who has intentionally made false claims to the government to get more money.
In a qui tam case, the whistleblower is called a relator. The relator files the lawsuit for the government, and the government acts as the plaintiff. Whistleblowers in qui tam lawsuits can receive a portion of the money awarded to the government as part of the suit.
Examples of Medicare Fraud
There are many ways healthcare providers and other individuals commit Medicare fraud. Some common examples include:
- Submitting claims to Medicare using someone else’s Medicare number
- Charging for unnecessary services or medical equipment
- Billing Medicare for healthcare services that were never provided
- Purposely using the wrong codes on Medicare claims to receive a higher payout
- Double-billing for a medical service that was only performed once
- Submitting claims for supplies or prescriptions not given to a patient
- Receiving kickbacks for issuing referrals
- Offering incentives for Medicare patients to come to a healthcare provider
This list isn’t an exhaustive rundown of ways a healthcare provider can engage in Medicare fraud. Any time a false claim is submitted to Medicare, Medicare fraud has occurred and should be disclosed to CMS.
Examples of Medicare Fraud
Some illegitimate companies see Medicare fraud as an easy way to make money. Some companies target senior citizens and other Medicare patients to gain access to their Medicare number. A company involved in this kind of scam might approach a Medicare patient as if they are a legitimate Medicare provider or health insurance company.
After getting the Medicare patient’s number, the company can then make false claims to Medicare. This is similar to identity theft, except the company’s intention is to make money by defrauding Medicare by submitting fake medical bills.
Reporting Healthcare Fraud
If you know your employer has engaged in Medicare fraud practices like overbilling for services or upcoding, you can file a report with CMS. Depending on the facts of the case, CMS might conduct a Medicare audit or investigate the healthcare facility.
Medicare fraud is a serious offense. At the very least, the health service provider will be removed from the Medicare program. By intentionally submitting false claims to Medicare to get more money, a healthcare provider can also face legal consequences and risk having their medical practice permanently shut down.
Examples of Medicare Fraud
Healthcare employees are not the only ones who can disclose fraudulent Medicare claims. Anyone who has knowledge of medicare fraud can file a report with CMS. Even if you only suspect a medical provider is overbilling or upcoding for services billed to Medicare, you can still alert CMS.
However, to file a whistleblower lawsuit, you will need to have more specific information about the acts of fraud. It’s common for Medicare fraud whistleblowers to work at the company accused of fraud because they know clear details about deceptive practices.
Whistleblower Lawsuits in California
California has a False Claims Act outlining requirements for whistleblower lawsuits. Under the California False Claims Act, a whistleblower can file a lawsuit when they are aware a government agency or program, like Medicare, is being defrauded.
In California, a whistleblower is entitled to some of the compensation the government receives from the lawsuit.
If you’re aware of Medicare fraud and want to file a whistleblower lawsuit in California, a whistleblower attorney can walk you through the legal process and compile evidence for your case. There can be a lot of documentation involved in a whistleblower lawsuit. Having the support and guidance of a law firm makes the entire process easier.
Retaliation Lawsuits for Whistleblowers
One of the biggest concerns for most whistleblowers is fear of retaliation from their employer. Retaliation can extend beyond just losing your job. Even if you aren’t fired, you could be demoted or subjected to a pay cut if your employer finds out you reported them.
However, the law offers whistleblower protections. Exposing fraudulent medical practices is in the best interests of the public. If you lose your job or are treated poorly at work after filing a whistleblower lawsuit, a law firm that handles fraud cases can work with you to file a retaliation lawsuit.
California Medicare Whistleblower Lawyers Who Can Help
It can be intimidating for a whistleblower to report Medicare fraud. You might be afraid you will lose your healthcare job or get blacklisted from working in the healthcare industry. However, Medicare fraud is a serious crime and should be disclosed if you discover it’s happening in your workplace.
A whistleblower attorney experienced in Medicare fraud cases can work with you to make sure your rights are protected. Filing a whistleblower lawsuit for Medicare fraud can be confusing to figure out on your own. Enlisting the assistance of a Medicare fraud attorney to file your whistleblower claim can make the legal process easier to navigate.
At Cutter Law, our California whistleblower attorneys are available to discuss your experience with Medicare fraud.
Contact us today to schedule a free, confidential consultation with one of our whistleblower lawyers.
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