Updated On May 15, 2024

By SaraNextGen

How to Report a Suspected Medicare Fraud Anonymously and Increase Your Chances of the Whistleblower

There are many healthcare industry incidents that can be viewed as fraud by law enforcement agencies. All stakeholders, be it patients, medical professionals or contractors, can get involved in fraudulent activities.

• Federally-funded healthcare program Medicare was initiated in 1965 to provide healthcare benefits to senior citizens aged 65 and above, persons under 65 with long-term disabilities, and any other individual with long-term renal disease.

• The federal government’s healthcare program is designed to help the program beneficiaries but fraudulent activities are conducted in due course of time, like billing mistakes and the most alarming one, Medicare fraud and abuse. Medicare billing fraud means knowingly billing the federal healthcare program, possibly over and over again, for products and services that were medically not required or accurately coded. Common instances of Medicare fraud include:

• Identity theft to wrongfully obtain medical goods and services

• Billing Medicare for appointments that the patient failed to keep

• Knowingly submitting false claims misrepresenting facts

• Falsifying certificates or treatment plans

• Billing for brand name drugs when generics are administered

• Inflating or falsifying cost report, kickback for patient or business referrals, and

• Using false information to mislead patients to enroll in Medicare plan

• Medicare fraud is illegal, so it’s more serious than a billing error. You can file a whistleblower or Qui Tam case against the wrongdoers through your whistleblower law firm.

• Civil and criminal penalties for fraud

• Civil penalties for submitting false claims may include fines of up to three times the amount of damages sustained by the government. Additionally, there is the provision in FCA for civil penalties of up to $11, 000 per false claim submitted to the government. There is also a criminal FCA statute under which an offender may be imprisoned in addition to being made liable to pay fines.

• Who can blow the whistle on fraud?

• It’s not only the patients who can report fraud, but doctors, administrators, pharmacists, medical employees, suppliers, vendors, specialists and nurses have access to the information and insider knowledge that puts them in the ideal position to report an uncovered pattern of frauds. As an insider with knowledge of suspected fraud, it’s your ethical responsibility to report it and help stop the illegal conduct from continuing.

• Signs of suspected Medicare fraud

• If you suspect Medicare fraud, you should report it right away. Some signs of a suspected false claim include high employee turnover in areas most vulnerable to fraud, refusal of promotions due to the the fear of detection, lifestyle changes and rewriting records under the guise of presenting them neatly. 

• However, you must know the correct procedure of how to report Medicare fraud. There are well-defined procedures and forms to be submitted to file a qui tam case. Moreover, you should not bring the fraud to the public domain right away, neithe should it already be under investigation by the government or already reported by some other individual. The claim must be legitimate and the relator or whistleblower must not be involved in the fraudulent act. The claim has to be filed within the Statute of Limitations of an FCA claim. Moreover, the false claim act requires you to hire the services of a whistleblower law firm to file a qui tam case.

• How much you can earn in award for providing insider information?

• If you are able to provide information to the government that brings a successful FCA claim, then you become eligible to receive a reward of up to 30% of the government’s total recovery. For example, if the government is able to recover $20 million based on your information, you could be awarded up to 6 million for blowing the whistle and helping the government combat the fraud.

• Reporting anonymously

• It is often possible for you to remain anonymous while the government decides whether or not to proceed with your information, or till the investigations have reached a certain stage. However, your anonymity may be lost at a later stage. If you are eligible for a larger whistleblower award while  also help the government stop wrongdoers from perpetuating fraud on the US taxpayers, you may, however decide that revealing your identity is worth it.

• How to report suspected Medicare fraud

• If you are wondering how to report suspected Medicare fraud, call Brown LLC, the trusted whistleblower law firm that has some of the best Medicare whistleblower attorneys to help you at all steps of how to report Medicare fraud. The leading whistleblower law firm is headed by a former FBI Special Agent. Brown LLC and has successfully recovered tens of millions in awards for its clients through whistleblower cases.

• The best Medicare whistleblower attorneys at Brown LLC will help you with how to report suspected Medicare fraud for the best outcomes in your favor. The specialized whistleblower law firm will file an action (lawsuit) under seal (secretly) against the party responsible for Medicare fraud based on your information. A copy of the action will be officially submitted to the Office of the Inspector General (OIG).

• Protecting you from retaliation

• Besides striving to maximize your whistleblower award, Brown LLC will also will invoke the legal whistleblower protection provisions to protect you from retaliatory action by your former or current employer, such as demotion, unjustified transfer, threats, discriminatory behavior, etc. Moreover, Brown LLC won’t charge anything from you till you are awarded your whistleblower claim.