Who Can Serve As a Medicaid Whistleblower?
Learn About Who is Eligible to Report Medicaid Fraud Under the False Claims Act
Whistleblower Team Lead
Former DOJ Attorney
Whistleblower Team Lead
Whistleblower Team
Former U.S. Attorney and District Attorney
Whistleblowers play an important role in exposing Medicaid fraud and helping the federal government hold bad actors accountable. If you have information about fraud under any Medicaid program, you may be eligible to serve as a whistleblower—and you could become eligible to receive a whistleblower reward if you come forward.
With that said, not everyone is eligible to serve as a Medicaid whistleblower. There are specific eligibility requirements for serving as a whistleblower in cases involving fraud under Medicaid and other government healthcare programs. Determining eligibility requires an in-depth assessment on a case-by-case basis, and this makes it important to speak with an attorney who has experience representing whistleblowers in False Claims Act cases.
Individuals Who Can Report Fraud Under Medicaid Programs
Keeping in mind that determining eligibility requires a case-by-case assessment, there are certain categories of individuals who are generally eligible to blow the whistle on Medicaid fraud if they otherwise qualify. These categories of individuals include:
- Healthcare Provider Employees – Employees of all types of healthcare providers can serve as whistleblowers against their employers and other companies in the healthcare industry. If you have information about Medicaid fraud anywhere in the federally funded healthcare system, a whistleblower attorney at our firm may be able to help you come forward.
- Nursing Home Employees – You may also be eligible to file a whistleblower complaint if you are a nursing home employee. Nursing homes can receive payments under Various Medicaid programs; and, when they receive payments in violation of federal law, they can (and should) be held accountable.
- Daycare Center Employees – Daycare centers can receive Medicaid funds through programs designed to help low-income families. If you suspect fraud at a daycare center (or a purported daycare center), our attorneys can determine if you are eligible to file a qui tam lawsuit under the False Claims Act.
- Pharmaceutical Company Employees – Employees of pharmaceutical companies can file whistleblower complaints in cases involving fraud related to prescription medications—including (but not limited to) improper payments of kickbacks and referral fees. Pharmaceutical companies can also be held liable for improper marketing practices and other forms of fraud.
- Medical Device Manufacturer Employees – Medical device manufacturers can also face Medicaid whistleblower claims related to a broad range of deceptive practices and other fraudulent activities. Here too, this includes (but is not limited to) paying unlawful kickbacks and referral fees to doctor’s offices, hospitals, and other legitimate providers.
- Managed Care Organization Employees – Employees of managed care organizations can help the government seek civil penalties (and, in some cases, criminal penalties) by reporting fraud involving Medicaid programs. Along with the federal False Claims Act, several other federal laws govern managed care organizations’ operations, and these organizations can face whistleblower lawsuits on various grounds.
- Employees of Contractors and Subcontractors – Employees of contractors and subcontractors can serve as whistleblowers—whether their employers bill the Centers for Medicare and Medicaid Services (CMS) or they are aware of fraud at another organization. If you have information about any organization improperly receiving federal funds through Medicaid, you may be eligible to file a whistleblower claim (and seek a whistleblower reward) in federal district court.
- Former Employees – Just as current employees can file whistleblower claims, former employees can come forward as whistleblowers as well. If you are aware of your former employer billing Medicaid for medically unnecessary procedures, falsifying medical records or billing records, or engaging in any other fraudulent practices to obtain taxpayer funds, we strongly encourage you to schedule a free and confidential consultation.
- Medicaid Beneficiaries and Family Members – Medicaid beneficiaries and their family members can also serve as whistleblowers in some cases. From forging patients’ signatures to providing unnecessary services for financial gain, healthcare providers and other entities can (and should) be held liable for all forms of fraud. If you believe that you have information about Medicaid fraud and have medical records or other supporting documentation, we encourage you to speak with one of our whistleblower attorneys right away.
- Citizen Journalists – Citizen journalists can also report Medicaid fraud—along with Medicare fraud and all other forms of health care fraud under government programs. If you have material evidence of fraud and are interested in filing a False Claims Act lawsuit, our attorneys can explain everything you need to know.
This list is not exhaustive. Ultimately, if you have information about Medicaid fraud (or potential Medicaid fraud) through any means, we strongly encourage you to contact us for more information. Whether you wish to remain anonymous or you are interested in coming forward publicly, our attorneys can explain the relevant legal processes and help you make informed decisions about your next steps.
5 Important Facts About Blowing the Whistle on Medicaid Fraud
Let’s say you are eligible to serve as a Medicaid fraud whistleblower. What do you need to know? Here are five important facts about coming forward:
1. The U.S. Department of Justice (DOJ) and U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) Rely on Whistleblowers to Come Forward
As we said above, whistleblowers play an important role in helping the government establish accountability for Medicaid fraud. The DOJ and HHS OIG both rely on whistleblowers to come forward, and the False Claims Act provides incentives for those who do.
2. The False Claims Act Includes Provisions for Whistleblower Protection and Compensation
Whistleblowers are entitled to strict confidentiality under the False Claims Act, and those who help the government successfully prosecute Medicaid fraud may be entitled to monetary rewards (it is not possible to report Medicaid fraud anonymously and seek a reward in most cases). The False Claims Act also prohibits retaliation against whistleblowers.
3. Blowing the Whistle on Medicaid Fraud Generally Involves Dealing with the Federal Government
While state governments play a role in combating Medicaid fraud, blowing the whistle generally involves dealing with the federal government. If you are considering contacting your state’s Medicaid Fraud Control Unit (MFCU), we strongly recommend speaking with one of our whistleblower attorneys first.
4. Blowing the Whistle on Medicaid Fraud is a Complex Process that Requires Experienced Legal Representation
Blowing the whistle on Medicaid fraud generally involves filing a federal lawsuit under the False Claims Act. This is a complex process that requires experienced legal representation. While you aren’t required to hire an attorney, we strongly recommend doing so—for both your best interests and the best interests of the federal government.
5. You Can Hire a Whistleblower Attorney to Advise and Represent You on a Contingency-Fee Basis
Hiring an attorney to help you blow the whistle on Medicaid fraud costs nothing out-of-pocket. At Oberheiden P.C., our whistleblower attorneys handle all federal False Claims Act cases on a contingency-fee basis.
FAQs: Serving as a Medicaid Fraud Whistleblower
What Should You Expect During the Government’s Medicaid Fraud Investigation?
If the government decides to investigate after you file a Medicaid fraud whistleblower complaint, you can expect the government to want you to play an active role in the process. When we represent whistleblowers in Medicaid fraud cases, we work directly with federal agents and prosecutors on behalf of our clients.
How Are Medicaid Whistleblower Rewards Calculated?
Medicaid whistleblower rewards are calculated as a percentage of the amount the government recovers. This percentage generally ranges from 15% to 30%, with rewards in the 25% to 30% range reserved for cases in which the federal government declines to intervene. The level of assistance that whistleblowers provide to the federal government is one of the most important factors for determining reward amounts under the False Claims Act.
Are There Different Rules for Reporting Healthcare Fraud, Nursing Home Fraud, and Daycare Fraud As a Medicaid Whistleblower?
All Medicaid fraud whistleblower cases are subject to the same basic rules under the False Claims Act. These rules are complex, so it is important to work with an experienced whistleblower attorney who can help you comply with all requirements and maximize your protections and potential rewards.
Are There Different Rules for Medicare and Medicaid Whistleblowers?
Medicare fraud and Medicaid fraud are both covered under the False Claims Act, so the same basic rules apply to both types of cases. If you have information about Medicare fraud or Medicaid fraud, our attorneys can file an appropriate qui tam lawsuit on your behalf and ensure you are fully protected throughout the process.
Are Federal Employees Eligible to Serve as Medicaid Fraud Whistleblowers?
Federal employees are eligible to blow the whistle on fraud, waste, abuses of authority, and other forms of wrongdoing both within and outside of the federal government. Multiple whistleblower statutes exist to protect federal employees, although they are generally not eligible to receive monetary whistleblower rewards.
Are You Eligible to Serve as a Medicaid Whistleblower? Find Out for Free
Are you wondering who can serve as a Medicaid whistleblower? Are you wondering if you can serve as a Medicaid whistleblower? If so, we want to hear from you. To speak with an experienced federal whistleblower attorney at Oberheiden P.C. in strict confidence, please call 888-680-1745 or request a free consultation online today.
