Many Americans are insured by health insurance paid for with federal or state government funds.
By far, the largest of the government sponsored healthcare plans are the Medicare and Medicaid programs.
These two programs provide health care coverage for as many as 95 million Americans, at an estimated cost in 2012 alone of more than $900 billion.
One of the primary reasons for the rise in health care costs is due to insurance fraud committed against these government health care programs.
Common types of Medicare and Medicaid fraud include:
- Billing for services not performed or items not furnished, such as X-rays.
- Up-coding, which is when the bill reflects a higher procedure than was performed.
- Misrepresentation, or changing a procedure code to depict a different service than what was actually performed.
- Unbundling, or breaking down components that are included in one service and billing for each item separately.
How to Report Insurance Fraud
In deciding to report Medicaid or Medicare fraud claims or other instances of insurance fraud, there are two ways to report fraud:
Submit an Anonymous Tip
One way to report Medicaid fraud or Medicare fraud is to submit an anonymous tip. However, this route may not be the most preferable as it may not be deemed credible.
If you decide to pursue this option, it is recommended you gather the essential information to provide a detailed explanation of the fraud being committed. The more information you can submit, the more likely your tip will be investigated.
You can report Medicare and Medicaid fraud anonymously to either the Office of Inspector General or the FBI via mail or phone.
File a False Claims Act Lawsuit
Another way to report Medicare fraud or Medicaid fraud is to file a whistleblower lawsuit. In this scenario, a whistleblower must find a qualified Medicare fraud lawyer or Medicaid Fraud lawyer who specializes in qui tam lawsuits.
In this avenue, the attorney files a lawsuit, called a qui tam lawsuit, and the lawsuit is sealed in order to protect the whistleblower’s anonymity and preserve the integrity of the investigation.
Nobody, including the press, defendants, and members of the public and court, has access to the contents. Also, because the enabling legislation provides for attorney fees, a plaintiff should not have any out-of-pocket costs associated with filing a qui tam lawsuit.
In successful False Claims Act lawsuits, the guilty party is generally ordered to repay the government triple the amount defrauded. The whistleblower who reported the fraud becomes entitled to 15 to 30 percent of the government’s reward.
Along with Medicare and Medicaid fraud, qui tam lawsuits are a powerful way for whistleblowers to help the government stop other kinds of fraud including:
- Pharmaceutical Company Fraud
- Department of Defense Fraud
- Government Contractor Fraud
Filing a Qui Tam Lawsuit
People take great personal and professional risks when they blow the whistle on fraud, such as Medicare and Medicaid fraud. Deciding how to report insurance fraud can be very stressful.
But if the qui tam lawsuit is successful, the financial reward provisions of the False Claims Act can help compensate for the risks. Whistleblowing also can give a person great personal satisfaction at having stopped wrongdoing.
The procedure for blowing the whistle on your employer under the False Claims Act involves the filing of a lawsuit by your attorney on your behalf and on behalf of the United States. This procedure includes several phases including collecting evidence of the fraud, drafting and filing the complaint, and the Government investigation.
As a whistleblower, having an experienced Medicare fraud lawyer or Medicaid fraud lawyer can help you navigate through this process.
In general, whistleblower and qui tam lawsuits are filed individually by each plaintiff and are not class actions.
Do YOU have a legal claim? Fill out the form on this page now for a free, immediate, and confidential case evaluation. The attorneys who work with Top Class Actions will contact you if you qualify to let you know if an individual qui tam lawsuit or whistleblower class action lawsuit is best for you. Hurry — statutes of limitations may apply.
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Join a Free Whistleblower, Qui Tam Lawsuit Investigation
If you believe that you have witnessed fraud committed against the government, you may have a legal claim. See if you qualify to pursue compensation and join a whistleblower lawsuit investigation by submitting your information for a free case evaluation.
An attorney will contact you if you qualify to discuss the details of your potential case.
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