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, free-standing clinics, skilled nursing facilities, and other health care providers that treat elderly patients receive a substantial portion of their income through claims paid by Medicare. But in order to be eligible for reimbursement by Medicare, those healthcare providers must follow Medicare’s rules about how and to whom they provide health care. But sometimes healthcare providers cut corners or disregard the rules in order to enrich themselves. These are some of the ways health care providers can commit Medicare:
- Paying bribes or kickbacks in return for patient referrals, where bribes can be anything of significant value
- Using a incorrect billing codes in order to receive higher reimbursements from Medicare than they would by using the correct billing code
- Billing for office visits, medical treatments, and lab tests that never occurred
- Ordering medically unnecessary lab tests or durable medical equipment
- Physicians, or other health care providers referring patients to other health care entities that they own – called “physician self-referrals”
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 consult with an experienced Whistleblower attorney right away. Reporting misconduct at your workplace is a legally protected activity. Employers cannot prevent employees from reporting potential fraud to the appropriate authorities, not even through non-disclosure provisions in employment contracts. Employers also cannot fire or take other adverse action against employees for doing so.
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.
How to File a Medicare Fraud Whistleblower Action
If you believe a health care provider has committed Medicare or Medicaid fraud, you should contact an experienced Whistleblower attorney immediately. Medicare Whistleblowers can be entitled up to 30 percent of any sum of money the government recovers from providers who have committed Medicare fraud, called a “Relator’s Award” – but only if the government is not already aware of the fraud, and you are the first person to report the suspected fraud to the government. Marchand Law has represented Whistleblowers alleging damages and penalties exceeding $1 billion.
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.