Do I Need to Hire a Medicaid Whistleblower Attorney?
Learn How an Attorney Can Help You Blow the Whistle on Medicaid Fraud
Whistleblower Team Lead
Former DOJ Attorney
Whistleblower Team Lead
Whistleblower Team
Former U.S. Attorney and District Attorney
While Medicare and Medicaid whistleblowers can come forward on their own, they can also engage a whistleblower law firm to represent them. To be absolutely clear, if you are thinking about serving as a Medicaid whistleblower, you are not required to hire an attorney to assist you.
But, just because you can come forward on your own, this doesn’t mean you should.
If you are thinking about blowing the whistle, there are several ways a team of experienced Medicaid fraud attorneys will be able to help you. We encourage you to keep reading to learn more, and then we invite you to contact us for a free, no-obligation consultation if you think you might be eligible to report fraud to the federal government.
5 Critical Ways an Experienced Attorney Can Help You as a Potential Medicaid Fraud Whistleblower
At Oberheiden P.C., our lawyers rely on extensive experience to help whistleblowers report Medicaid fraud, Medicare fraud, and fraud under all other federal healthcare programs. If you have (or believe you may have) information about fraud under the Medicaid program, here are just some of the ways our whistleblower lawyers can help:
1. Determining If the Information You Have Reflects a Violation of the False Claims Act, Anti-Kickback Statute, or Stark Law
To serve as a Medicaid fraud whistleblower, you must have credible information about a violation of federal law. Typically, this will be a violation of the False Claims Act, the Anti-Kickback Statute, the Stark Law, or some combination of the above.
The False Claims Act is the primary statute used to pursue whistleblower lawsuits, and violations of the Anti-Kickback Statute and Stark Law also constitute violations of the False Claims Act. With this in mind, whistleblowers can pursue Medicaid fraud cases under the False Claims Act involving violations including (but not limited to):
- Paying unlawful referral fees to medical providers
- Accepting unlawful remuneration for referring patients covered under Medicaid
- Billing Medicaid for medically unnecessary services
- Billing for ineligible services provided to Medicaid patients
- Other forms of government fraud involving Medicaid reimbursements
These are just some of the most common examples of the numerous forms of fraud that Medicaid whistleblowers can expose in False Claims Act cases. However, not all apparently unlawful practices will warrant qui tam lawsuits under the False Claims Act. An experienced Medicaid whistleblower attorney will be able to determine if the information you have in your possession warrants pursuing a qui tam case.
2. Determining if You Are Eligible to Serve as a Whistleblower and Seek a Financial Reward
Before you come forward, your attorney can also determine if you are eligible to serve as a whistleblower under the False Claims Act’s qui tam provisions and receive the protections (and potentially the financial incentives) that are available. Timing and other restrictions apply; and, if you are not eligible to come forward under the False Claims Act, it will be important for you to consider any other options you may have available.
Generally speaking, current and former employees of healthcare providers, nursing homes, in-home care providers, pharmaceutical companies, medical device companies, and other companies that provide (or are supposed to provide) designated health services or items are eligible to forward. Citizen journalists, patients, family members, and other individuals are generally eligible as well. However, due to the restrictions that apply in Medicaid whistleblower cases, assessing your eligibility is a critical first step toward making informed decisions.
3. Relying on Extensive Experience Exposing All Forms of Fraud in the Healthcare Industry
An attorney who has extensive experience handling healthcare fraud cases will be able to provide advice based on the specific circumstances of your case. While Medicaid fraud costs taxpayers tens of billions of dollars annually, blowing the whistle is a complex process that arguably isn’t as simple or straightforward as it should be.
In cases involving both legitimate providers and scammers, proving fraud requires clear evidence; and, again, serving as a Medicaid whistleblower generally involves filing a qui tam lawsuit in federal court. An experienced attorney will be familiar with the processes, procedures, and government agencies involved, and will be able to rely on his or her insights to guide you forward with confidence and with your best interests in mind.
4. Working with the Government on Your Behalf While Helping Protect Your Identity from Disclosure (if Desired)
The U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) hold primary responsibility for conducting healthcare fraud investigations involving improper billings and fraudulent schemes under Medicaid. Companies and individuals accused of committing fraud can face invasive scrutiny, and this scrutiny can lead to civil penalties or criminal prosecution depending on the nature of the accusations involved.
In qui tam cases under the False Claims Act, a key step in the process comes when the government decides whether to intervene. If the government chooses to intervene, the DOJ will take over your case and pursue civil or criminal charges in federal court. If the government chooses not to intervene, you will need to decide whether you want to continue pursuing your case independently.
When you hire a Medicaid whistleblower attorney to represent you, your attorney will work with the government on your behalf during its investigation and during its decision regarding intervention. This way, you can feel confident that you are helping to maximize both the government’s chances of pursuing a successful enforcement action and your chances of receiving a whistleblower reward.
5. Helping You Make Informed Decisions and Providing Custom-Tailored Legal Advice Throughout the Process
While whistleblowers play a key role in the government’s ongoing fight against Medicaid fraud, serving as a whistleblower presents a variety of challenges. This alone is reason enough to put an attorney who has experience representing whistleblowers on your side. At Oberheiden P.C., we work closely with our clients to ensure that they are making informed decisions throughout the process—from deciding whether to serve as a whistleblower to deciding how much to seek if their cases are successful.
We Help Whistleblowers Expose Medicaid Fraud (and Other Forms of Healthcare Fraud) At No Out-of-Pocket Cost
When assisting whistleblowers with reporting Medicare fraud, Medicaid fraud, and fraud under other federal healthcare benefit programs, our attorneys provide legal representation on a contingency basis. This means that it costs nothing out-of-pocket to engage our law firm to advise and represent you. If we assist you with securing a whistleblower reward, our legal fees will be calculated as a percentage of the monetary compensation we help you recover. Otherwise, you owe us nothing.
FAQs: Engaging a Law Firm to Report Medicaid Fraud to the Federal Government
Do I Need a Whistleblower Law Firm to File a Qui Tam Complaint for Medicaid Fraud?
While not required, engaging a whistleblower law firm to help you file a qui tam complaint for Medicaid fraud is strongly recommended. You must meet strict requirements to qualify as a whistleblower under the False Claims Act’s qui tam provisions, and a law firm experienced in representing whistleblowers can assist you at all stages of the process.
Do Medicare and Medicaid Whistleblowers Have to Pay Out-of-Pocket for Their Legal Representation?
No, Medicare and Medicaid whistleblowers do not have to pay anything out-of-pocket for their legal representation. Oberheiden P.C. handles all whistleblower cases on a contingency basis, meaning fees are only collected if the case is successful.
How Often Does the Government Accept Medicaid Whistleblower Cases?
Whether the government accepts a Medicaid whistleblower case depends on the veracity of the whistleblower’s allegations, the amount of taxpayer dollars at issue, and other factors. A whistleblower attorney can assess the likelihood of government acceptance and assist in preparing a qui tam complaint that meets all federal requirements.
Do I Need to Expose My Identity to Serve as a Medicaid Whistleblower?
Whistleblowers under the False Claims Act are generally required to disclose their identities to the federal government. However, the government is required to protect whistleblowers’ identities, and federal law prohibits companies from retaliating against them. Hiring a whistleblower attorney can further help protect your identity throughout the process.
What if I Have a Case that Does Not Involve Health Care Fraud?
While many Medicaid fraud cases involve health care fraud, they can also include daycare center fraud, nursing home fraud, and other forms of fraud. Whistleblowers can report all forms of Medicaid fraud under the False Claims Act. However, all whistleblowers must come forward through the appropriate channels, which is why working with an experienced attorney is strongly recommended.
Schedule a Free and Confidential Consultation with a Medicaid Whistleblower Attorney
If you would like to know more about hiring an attorney to help you expose Medicaid fraud, we strongly encourage you to get in touch before you make any decisions. To schedule a free and confidential consultation as soon as possible, please call 888-680-1745 or tell us how we can get in touch online now.
