Cheating Medicaid is illegal and costs taxpayers billions each year and whistleblowers are critical in recovering that money.
Many U.S. states have False Claims Acts and the U.S. has a federal False Claims Act used to recover taxpayer money lost to medical provider fraud and calls for treble (triple) damages from hospitals, doctors, pharmacies, home health care groups and other healthcare provider caught in billing scams, kickback arrangements, or other schemes.
The False Claims Acts also have whistleblower provisions calling for cash rewards of 15 to 30 percent of the money the state or the U.S. recovers for tipsters who are:
- The first to report the fraud with,
- Non-public information that,
- Helps make a Medicaid or Medicare fraud case.
All False Claims Acts also protect tipsters who blow the whistle with anti-retaliation provisions making it illegal to fire or harass an employee who reports fraud.
3 Easy Steps to Help you Decide Whether You Should Report Medicaid Fraud
You May Be Entitled to a Large Cash Award for Reporting Fraud
Step 1: Select the type of healthcare fraud that you feel best applies to your situation from the list below:
- False Documentation – Altering reports or cost claims, falsifying medical records, incomplete record maintenance, billing scams
- Homecare or Hospice Fraud – Billing Medicaid for higher level of care than provided, services not provided, no physician certification, falsifying records, fake eligibility schemes, inadequate services
- Stark Law Violations – Referring patients to a medical provider in which you have an ownership interest
- Anti-Kickback Violations – Medical providers offering financial or other incentives in return for medical referrals of patients
- Pharmacy & Pharmaceutical Fraud – Billing for pharma or medical products without proper prescription, altering or forging documents, nurse completed prescriptions
- Ambulance & EMS Scams – Illegal deals between hospitals and ambulance companies, billing for supplies or services not provided, billing for higher services levels, unnecessary transport
- Medical Necessity Fraud – Billing for medically unnecessary product or services not medically necessary
- Billing Schemes - Medical providers billing Medicaid for products or services not provided, upcoding, unbundling, double billing, submitting claims for ineligible patients
Medicaid Fraud Education Center
Warning to Tipsters:
There is a specific process Medicaid whistleblowers must follow to be eligible for a False Claims Act or other whistleblower cash award. Some tipsters have been paid millions, others nothing – so before reporting Medicaid Fraud be sure to read over our 10 Step Whistleblower Guide to Reporting Medicaid Fraud.
Medical provider billing scams, physician kickbacks & falsifying records are Medicaid fraud More
Tipsters who are first to report can earn large cash rewards for reporting Medicaid fraud More
31 States' False Claims Acts protects whistleblowers with big anti-retaliation penalties More
What Does Medicaid Fraud Cost Taxpayers?
Medicaid Whistleblower Rewards