Stop Medicare Fraud: What You Need to Know

If you work for a doctor’s office that mostly treats elderly patients, or if you provide home health services to seniors, then a large portion of your employer’s income comes from Medicare, a federally funded health insurance program for people aged 65 or older. Some patients become eligible for Medicare benefits before age 65 if they have qualifying chronic illnesses, such as amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease, or if their chronic kidney disease has advanced to a certain stage. Each year, the federal government spends hundreds of billions of dollars on Medicare, which is the main source of healthcare for approximately one-seventh of the U.S. population. When physicians and other healthcare providers defraud Medicare by knowingly entering false information on claims that they submit for payment, they not only cause financial harm to taxpayers but also take away resources from elderly people who rely on Medicare for medical treatment, nursing care, and medications they need to stay healthy. The law protects employees who report Medicare fraud from retaliation by their employers. If you have witnessed Medicare fraud or other misconduct in your workplace, contact a Dallas whistleblower claims lawyer.



How Does Medicare Fraud Happen?

Healthcare providers submit billing claims to Medicare, much as they would to privately owned insurance companies. As with private health insurance, the patient’s share of responsibility for the cost of treatment is pre-determined as a flat fee or a percentage of the sticker price of services offered, and Medicare pays the rest. Doctors’ offices, hospitals, and skilled nursing facilities that treat elderly patients receive a substantial portion of their income through claims paid by Medicare. Sometimes healthcare providers attempt to enrich themselves by making false statements on Medicare claims.  These are some of the forms that Medicare fraud can take:

• Using a different billing code to make it look like you provided a more expensive service than you actually provided
• Billing for office visits, medical treatments, and lab tests that never occurred
• Ordering medically unnecessary lab tests and durable medical equipment
• Filing duplicate claims

There have even been instances where a clinic or durable medical equipment company will pay kickbacks to a Medicare-authorized physician in exchange for using that physician’s provider number to file false claims with Medicare.

Reporting Healthcare Fraud is a Protected Activity Under Employment Laws

If you have witnessed your employer or your coworkers filing false Medicare claims at your workplace, you should report the incident, whether to Medicare itself or to law enforcement. Reporting misconduct at your workplace is a legally protected activity. Employment law defines protected activities as those which inconvenience your employer but do not constitute misconduct on the employee’s part. Therefore it is against the law for your employer to retaliate against you if you do them.

Reporting violations of the law to the relevant regulatory body is a protected activity; this includes reporting Medicare fraud. It is also a protected activity to cooperate with a civil or criminal investigation into alleged breaches of the law at your workplace. Outside the context of Medicare fraud, other protected activities include requesting an unpaid family leave or medical leave under FMLA, requesting accommodations for a disability, filing a workers’ compensation claim about a work-related injury, reporting workplace safety violations to OSHA, and complaining about employment discrimination at your workplace to your employer’s human resources department or to the EEOC.

Retaliation is when an employer takes an adverse action to punish you for engaging in the protected activity. Adverse actions can include excessive scrutiny of your work, unfairly negative performance reviews, changing your schedule or work duties when you did not request this, demotion, denial of promotions or raises, or termination of employment. If an employer says that you are losing your job because of corporate layoffs and offers you a separation agreement with a severance package, you should think twice before you sign it. By signing the separation agreement, you waive the right to sue your employer for wrongful termination of employment. You should not sign if you think that the corporate downsizing is just an excuse and your employer is really firing you in retaliation for reporting Medicare fraud, even if your employer has not told you directly that they know that you reported the fraud.

How to File a Medicare Fraud Whistleblower Action

If you have seen your employer file false claims with Medicaid, or if you have not witnessed it directly but have seen enough evidence of it to have a reasonable suspicion that it is going on, then you should contact a whistleblower cases lawyer immediately. If you are the first person to notify the government that your employer is defrauding Medicare, then you might be entitled to a relator’s award. A relator is just another way of saying a whistleblower, someone who notifies authorities about fraud or other types of financial misconduct at a company or institution. The relator’s award is often calculated as a percentage of the money that the court awards to the government after it sues the party that has been defrauding it. Therefore, if your employer has filed several millions of dollars worth of false claims with Medicare, then your relator’s award could be for a substantial amount of money.

Of course, you are only eligible for a relator’s award if you have notified the government of an act of fraud that they did not already know about.  Therefore, you should contact a lawyer now instead of later about your suspicions that Medicare fraud is happening at your workplace. If your employer has gotten so used to getting away with fraud that they are starting to be sloppy or greedy with their false claims, time is limited for you to speak up before Medicare decides to investigate even without your whistleblower claim.

Contact Marchand Law, LLP About Medicare Fraud Lawsuits

A whistleblower case attorney can help you report Medicare fraud at your workplace. Contact Marchand Law, LLP in Dallas, Texas, to discuss your case.