Medicaid Whistleblower Lawyer

We Help Employees, Former Employees, Citizen Journalists, and Other Whistleblowers Report Medicaid Fraud Nationwide

Medicaid fraud costs U.S. taxpayers billions of dollars annually. Collectively, Medicare and Medicaid fraud are among the biggest sources of taxpayer losses across the entire federal government. Along with fraud perpetrated by healthcare providers, daycare providers, and other businesses, this includes fraud perpetrated by criminal actors who have no legitimate business with Medicaid.

If you have information about Medicaid fraud, we strongly encourage you to get in touch. Our whistleblower attorneys help employees, former employees, citizen journalists, and other individuals expose all forms of fraud, waste, and abuse (FWA). We represent Medicare and Medicaid whistleblowers nationwide, and our attorneys rely on extensive experience to help the government prosecute fraud under all federal healthcare programs.

Medicaid Fraud is a Pervasive Issue in the Healthcare Industry

Medicaid fraud is a pervasive issue in the healthcare industry. As revealed by recent investigations, it is a pervasive issue in daycare and other industries in which federal funding is available as well. According to the U.S. Government Accountability Office (GAO), Medicaid fraud costs taxpayers more than $50 billion annually, and it accounts for more than 20% of improper payments under all federal programs.

This is why it is important for whistleblowers to report fraud when they can.

If you have information about Medicaid fraud in any industry, our whistleblower attorneys can help you make an informed decision about whether to come forward—and, if you decide to come forward, we can work with the federal government on your behalf. We handle whistleblower cases involving all Medicaid programs, including Child Care Assistance Programs (CCAP) and Home & Community-Based Services (HCBS) programs, among others.

The U.S. Department of Health and Human Services (HHS) Relies on Whistleblowers to Come Forward

The U.S. Department of Health and Human Services (HHS) is the government agency that holds primary responsibility for uncovering Medicaid fraud. Its Office of Inspector General (HHS OIG) conducts investigations targeting suspected fraudulent activities, and it works with the U.S. Department of Justice (DOJ) to pursue criminal charges when warranted.

With that said, HHS relies heavily on whistleblowers to come forward.

While HHS has the authority to audit Medicaid-participating providers and conduct healthcare fraud investigations when warranted, it only has the resources to scrutinize a small fraction of the businesses that receive funding through Medicaid. This is a big part of the reason why Medicaid fraud is so pervasive. Whistleblowers help HHS uncover fraud under government healthcare programs that it wouldn’t uncover otherwise, and the False Claims Act provides both whistleblower protections and financial incentives for those who report government fraud.

Medicaid Fraud Whistleblowers Play an Important Role in Exposing FWA

As a result, Medicaid fraud whistleblowers play an important role in exposing all forms of fraud, waste, and abuse (FWA). Medical providers, daycare providers, nursing homes, pharmaceutical companies, and other businesses and individuals that receive payments directly or indirectly from Medicaid can—and should—be held accountable for committing fraud at the expense of U.S. taxpayers. At Oberheiden P.C., we help Medicaid fraud whistleblowers expose fraud by legitimate providers as well as fraudulent schemes perpetrated by individuals and criminal enterprises, and we protect our clients’ identities while serving as their liaison with the federal government throughout the legal process.

Common Examples of Medicaid Fraud

Medicaid fraud can take many different forms. Depending on the circumstances involved, committing Medicaid fraud can expose companies and individuals to civil penalties or criminal prosecution under federal law. While Medicaid compliance is enforced at the state and federal levels, whistleblowers will want to expose fraud involving Medicaid services to federal authorities in nearly all cases.

This is because strong whistleblower protections exist at the federal level. The False Claims Act—the primary federal whistleblower law that applies in Medicaid fraud cases—entitles eligible whistleblowers to financial rewards as well. At Oberheiden P.C., our experienced attorneys represent whistleblowers in federal cases involving all forms of Medicaid fraud, including (but not limited to):

Medicaid Fraud Schemes

Whistleblowers can report Medicaid fraud schemes that involve obtaining taxpayer funds for non-existent businesses and other forms of criminal misconduct. Recent investigations suggest that such fraud is an issue in states across the country, and prosecuting this form of fraud is currently a top priority for HHS and the DOJ.

Billing for Medically Unnecessary Services

Medicaid only covers designated health services, and it only covers these services when they are medically necessary. Billing the government for unnecessary medical services is a common form of health care fraud under Medicaid and other federal health care programs. Whether intentional or inadvertent, billing Medicaid for unnecessary medical services is a violation of the False Claims Act that whistleblowers can expose by filing a qui tam lawsuit.

Falsifying Patient Records

Falsifying patient records is a common form of Medicaid fraud as well. While patient care is supposed to be at the center of all health care practices, far too many practices put their profits first. When health care practices falsify patient records in order to bill Medicaid for medically unnecessary services or services not provided, this is another clear form of fraud that whistleblowers can—and should—expose in federal court.

Taking Advantage of Medicaid Patients

Along with falsifying patient records, taking advantage of Medicaid patients is another very real issue. In most cases, this involves providing services to Medicaid patients that are not medically necessary in order to bill the federal government. Providing unnecessary medications and prescriptions solely for the purpose of billing Medicaid is a pervasive issue as well. These, too, are clear violations of the law that an experienced whistleblower attorney at our firm can help you expose to the government.

Fraudulent Medicaid Billing

Fraudulent billing is among the most common forms of not only Medicaid fraud, but of Medicare fraud and fraud under other federal health care programs as well. Common examples include upcoding and unbundling, but all forms of improper billing violate the False Claims Act. If you believe that you have information about any form of billing fraud, we strongly encourage you to speak with a Medicaid whistleblower lawyer at our firm promptly.

Anti-Kickback Statute and Stark Law Violations

The Anti-Kickback Statute and Stark Law prohibit physicians, hospitals, pharmacies, and other healthcare providers from paying for patient referrals using funds received through Medicaid. Paying illegal referral fees and accepting illegal kickbacks for referring patients both violate the law. While there are limited exceptions, if you are aware of any direct or indirect financial relationship involving patient referrals, we strongly encourage you to speak with an experienced whistleblower attorney at our firm about coming forward.

Off-Label Marketing and Other Violations of Federal Law

Off-label marketing by pharmaceutical companies that bill Medicaid and other violations of federal law can also support whistleblower complaints under the False Claims Act. At Oberheiden P.C., we handle all types of whistleblower cases under the False Claims Act against pharmaceutical companies, healthcare providers, and other parties. Regardless of the specific form of fraud you are interested in exposing, our experienced attorneys can help you make informed decisions, and we can represent you in federal whistleblower litigation at no out-of-pocket cost to you.

Exposing Healthcare Fraud Usually Involves Filing a Whistleblower Complaint Under the False Claims Act

While there are several ways to expose Medicaid fraud (and other forms of healthcare fraud), coming forward as a whistleblower usually involves filing a whistleblower complaint under the False Claims Act. Here are some of the key reasons why:

• The False Claims Act Prohibits “False and Fraudulent Claims” Under Medicaid – False Claims Act cases initiated by whistleblowers can involve any type of “false or fraudulent claim” under Medicaid. This includes false and fraudulent claims by healthcare providers and other legitimate businesses as well as fraudulent claims by criminal enterprises.
• The False Claims Act Allows for Both Civil and Criminal Enforcement – Inadvertently submitting an improper request for Medicaid reimbursement is a civil violation of the law, while intentionally committing Medicaid fraud is a criminal offense. Whistleblowers can report both types of violations under the False Claims Act.
• The False Claims Act Protects Whistleblowers’ Identities – When you come forward as a whistleblower under the False Claims Act, the federal government will protect your identity. Your identity will also be protected under the attorney-client relationship. While you must disclose your identity to the government in order to be eligible for a monetary award under the False Claims Act, our attorneys will work with the government to protect your identity by all legal means available.
• The False Claims Act Protects Whistleblowers Against Retaliation – Along with protecting whistleblowers’ identities, the False Claims Act also protects whistleblowers against retaliation in the event that their identities are made known. Employer retaliation is strictly prohibited, and whistleblowers who experience retaliation are entitled to seek damages and other remedies.
• Qui Tam Whistleblowers May Be Entitled to Monetary Awards – Under the qui tam provisions of the False Claims Act, whistleblowers who help the government recover taxpayer funds are entitled to a monetary award. In Medicaid fraud cases, these awards are typically between 15% and 30% of the amount recovered.

Our Lawyers Have Extensive Experience in Federal Healthcare Fraud Cases

At Oberheiden P.C., we have extensive experience in federal healthcare fraud cases. This includes cases involving large-scale Medicaid fraud and Medicare fraud. When you are thinking about blowing the whistle, your choice of legal representation matters. Here are just some of the reasons why Medicaid whistleblowers choose our attorneys to work with the federal government on their behalf:

• Experience Representing Healthcare Fraud Whistleblowers – We have experience representing healthcare fraud whistleblowers in cases Under the False Claims Act. When you need to comply with the qui tam filing procedures and work with federal authorities to expose fraud involving Medicaid, experience matters. We can use our experience to help you make informed decisions and advise you every step of the way.
• Experience Prosecuting Healthcare Fraud at the DOJ –Several of our whistleblower attorneys have prior experience prosecuting healthcare fraud at the DOJ. These former federal prosecutors are intimately familiar with how the federal government conducts Medicaid fraud investigations and pursues both civil and criminal enforcement.
• Nationwide Representation for Qui Tam Cases Under the False Claims Act – We are able to represent Medicaid whistleblowers nationwide in qui tam cases under the False Claims Act. No matter where you are located, we can work with you remotely; and, if you decide to blow the whistle, our attorneys can file a qui tam lawsuit in the appropriate federal court on your behalf.
• A Proven Track Record in Qui Tam Litigation – Along with our experience, we have a proven track record in qui tam litigation. Regardless of the specific form of fraud you are prepared to expose and the party (or parties) involved, we are more than confident in our ability to work effectively with the federal government on your behalf. Of course, there are no guarantees of success, and we cannot compel the government to take your case.
• A Free Evaluation and No Out-of-Pocket Costs – If you are thinking about serving as a Medicaid whistleblower, our attorneys can provide a free case evaluation so that you can make an informed decision about coming forward. We are more than happy to provide all of the advice and insights you need, and we will not pressure you to make a decision one way or the other. If you decide to serve as a whistleblower, we will handle your case at no out-of-pocket cost to you.

FAQs: Serving as a Medicaid Fraud Whistleblower

Speak with an Experienced Medicaid Whistleblower Lawyer in Confidence Today

Are you thinking about blowing the whistle on Medicaid fraud? If so, we encourage you to contact us promptly for more information. To speak with a senior whistleblower lawyer at Oberheiden P.C. in confidence as soon as possible, call 888-680-1745 or tell us how we can reach you online now.

Further Information About Our Medicaid Whistleblower Lawyer Services

• Whistleblower Lawyers
• Do I Need to Hire a Medicaid Whistleblower Attorney?
• Medicaid Fraud Whistleblower Rewards
• Medicaid Whistleblower Process
• Who Can Serve As a Medicaid Whistleblower?
• What is Medicaid Fraud?
• Medicaid Whistleblower