Medicaid Whistleblower Rewards

Learn About Seeking a Whistleblower Reward for Reporting Medicaid Fraud Under the False Claims Act

Healthcare providers that commit Medicaid fraud deserve to be held accountable. So do pharmaceutical companies, nursing homes, daycare centers, and all other parties that improperly obtain funds through Medicaid. If you have information about Medicaid fraud, you may be eligible to serve as a federal whistleblower—and, if you decide to come forward, you could become eligible for a whistleblower reward.

The U.S. government pays Medicaid fraud whistleblower rewards to individuals who come forward under the federal False Claims Act. The False Claims Act prohibits “false and fraudulent claims” under all government programs, including Medicare and Medicaid. Our whistleblower attorneys represent individuals in False Claims Act cases nationwide. If you are eligible to come forward, our attorneys can pursue your False Claims Act case on your behalf, and we can work with the government to secure your reward if you become eligible to receive one.

Whistleblowers Who Expose Fraud Under Medicaid May Be Entitled to Monetary Rewards

When can you file a whistleblower lawsuit (and seek a whistleblower reward) under the False Claims Act? Under the statute’s qui tam provisions, whistleblowers can report all forms of fraud under the Medicaid program. This includes (but not limited to):

• Medicaid Billing Fraud – Medicaid billing fraud is easily among the most common False Claims Act violations in the federally funded healthcare system. This includes upcoding, unbundling, phantom billing, falsifying billing records, and all other forms of fraudulent billing that result in the loss of taxpayer dollars.
• Billing for Medically Unnecessary Services – Healthcare providers can only bill Medicaid for services that qualify as “medically necessary” under the program’s billing guidelines. This applies across the board—from clinical laboratory services and imaging services to outpatient hospital services and home health services. If healthcare providers bill for medically unnecessary services provided to a Medicaid patient, this constitutes fraud.
• Billing for Services Rendered by Excluded Physicians or Other Ineligible Providers – All services provided to Medicaid patients must be rendered by eligible providers. Even if a provider renders medically necessary designated health services, if the provider is ineligible, billing Medicaid constitutes fraud.
• Improperly Billing for Prescription Drugs – If a hospital, drug company, or any other business improperly bills Medicaid for prescription drugs, this is also a form of fraud that whistleblowers can expose under the False Claims Act. Taxpayer losses in these cases can be substantial, and this means that payments under the False Claims Act’s reward program have the potential to be substantial as well.
• Illegal Payments for Referring Patients – The Anti-Kickback Statute and Stark Law (also known as the Physician Self-Referral Law) prohibit providers from paying for referrals involving Medicare and Medicaid patients. When businesses or individuals improperly reward patient referrals, this is also a violation of federal law that can warrant a qui tam lawsuit under the False Claims Act.
• Medicaid Fraud Schemes – While many Medicaid fraud cases involve misconduct by health care providers and other businesses in the health care industry, whistleblowers can also report fraud perpetrated by daycare centers, nursing homes, and other parties. If you believe that you have information about any type of Medicaid fraud scheme, we strongly recommend speaking with a whistleblower attorney at our firm to find out if you may be eligible to seek a whistleblower reward.
• Other Violations Involving Patient Harm, Submitting False Claims, or Other Financial Misconduct – While the forms of fraud listed above are among the most common grounds for filing qui tam lawsuits under the False Claims Act, whistleblowers can (and do) report many other forms of fraud as well. As we said above, if you believe that you have information about any form of Medicaid fraud, we strongly encourage you to speak with one of our lawyers about exposing the fraud in federal court.

Along with handling Medicaid fraud cases, we handle Medicare fraud cases as well. In many cases, entities that improperly bill Medicaid will improperly bill Medicare as well. If you are aware of a healthcare provider committing Medicare fraud and Medicaid fraud, our attorneys can help you expose both forms of fraud to the federal government, and we can deal with the appropriate government agencies on your behalf. We also handle cases involving fraud under other government healthcare programs, including cases involving everything from improper financial interests to patient abuse in federally funded healthcare facilities.

Calculating Whistleblower Rewards in Healthcare Fraud Cases (Including Medicaid Fraud Cases)

In False Claims Act cases involving fraud under federal healthcare programs, whistleblowers can receive between 15% and 30% of the amount the government recovers. If the government intervenes in a whistleblower’s case, the whistleblower is generally entitled to between 15% and 25% of the government’s recovery; and, if the government declines to intervene, the whistleblower is generally entitled to between 25% and 30% of any funds the whistleblower recovers on the government’s behalf.

Regardless of whether the government intervenes,, whistleblower rewards in cases involving fraud under Medicaid and other government programs are determined based on three primary factors:

1. The Scope of the Health Care Fraud (i.e., Medicaid Fraud)

One key factor for determining the amount of a whistleblower award in any federal healthcare fraud case is the scope of the fraud exposed. While the government determines all whistleblower rewards on a case-by-case basis, generally speaking, the greater the scope, the larger the reward.  

2. The Civil Monetary Penalties or Criminal Fines Imposed

Since Medicaid whistleblower rewards are calculated as a percentage of the government’s financial recovery, the civil monetary penalties or criminal fines imposed play a direct role in determining whistleblowers’ reward amounts. Whistleblower rewards are available in cases prosecuted under both civil and criminal law.

3. The Whistleblower’s Contributions to the Case

The whistleblower’s contributions are also a major factor in calculating Medicaid fraud whistleblower rewards. If a whistleblower is able to provide direct evidence of fraud (i.e., billing records, financial statements, or video footage), this can be a key factor as well.

FAQs: Rewards for Exposing Medicaid Fraud in the Healthcare Industry

Schedule a Free Case Evaluation Today | We Represent Healthcare Whistleblowers Nationwide

If you have information about Medicaid fraud and are interested in seeking a monetary reward from the federal government, we strongly encourage you to contact us for more information. Our attorneys can assess your eligibility, and we can work with the federal government on your behalf if you are eligible to come forward. To schedule a free case evaluation with a senior whistleblower attorney at Oberheiden P.C. as soon as possible, please call 888-680-1745 or contact us confidentially online now.

Further Information About Our Medicaid Whistleblower Lawyer Services

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