New York NEMT Whistleblower
New York Medicaid Non-Emergency Medical Transportation (NEMT) Whistleblower Lawyers
Whistleblower Team Lead
Former DOJ Attorney
Whistleblower Team Lead
Whistleblower Team
Former U.S. Attorney and District Attorney
30 Wall Street, 8th Floor
New York, NY 10005
212-970-9468
In 2025, the New York Attorney General’s Office pursued multiple cases against Medicaid non-emergency medical transportation (NEMT) providers resulting in more than $13 million in penalties. However, recent reports suggest that the total value of fraudulent payments under New York’s Medicaid NEMT program may be far higher.
Allegations of submitting fraudulent claims to Medicaid can expose NEMT providers to criminal prosecution and substantial penalties. Along with investigations from state agencies in New York (and elsewhere), NEMT providers can also face federal investigations under the False Claims Act (FCA). However, the U.S. Attorney’s Office relies heavily on whistleblowers to come forward, and federal prosecutors can only pursue charges for fraudulent billing practices and other fraud schemes when they have the evidence to do so.
Experienced Federal Whistleblower Lawyers Handling NEMT Fraud Cases in New York
Our federal whistleblower lawyers represent individuals in New York and nationwide who are prepared to come forward with credible allegations of Medicaid noncompliance in the non-emergency medical transportation (NEMT) sector. If you are aware of fraudulent activity involving NEMT services or an NEMT provider’s Medicaid billings, we can work with the U.S. Department of Justice (DOJ) on your behalf.
Whether you have information about transportation services provided to ineligible Medicaid beneficiaries or you have evidence that executives willfully turned a blind eye to billing fraud, our lawyers can help you file a qui tam complaint under the False Claims Act and secure the protection (and potentially financial compensation) to which you are legally entitled. We serve as legal counsel for all qui tam whistleblowers at no out-of-pocket cost.
CBS News and Other Media Outlets Report Widespread Fraud Allegations Against NEMT Providers
While allegations of fraud involving day care centers and autism centers have dominated the headlines, the media has been covering fraud allegations against NEMT providers as well. This includes allegations against providers in New York and various other states across the country. In some cases, these allegations involve failure to meet Medicaid compliance requirements regarding industry standards, auditor reports, and proper documentation. In others, these allegations involve outright criminal fraud.
NEMT Providers Have Strict Compliance Obligations
All NEMT providers are subject to strict regulatory requirements, and they must take proactive measures to ensure that they meet these requirements on an ongoing basis. If they don’t—and if they improperly bill Medicare as a result—they can (and should) be held accountable for fraud. Some examples of the requirements that NEMT providers must meet on an ongoing basis include:
Taking Proactive Steps to Ensure Compliance
Like all companies that bill Medicaid, NEMT providers must take proactive steps to ensure compliance. This includes implementing clear policies and procedures that are designed to ensure both compliant service delivery and compliant billing.
Fraud Prevention
NEMT providers must also implement fraud prevention measures designed to detect suspicious activity and address it appropriately. This includes addressing even seemingly minor issues, as: (i) these issues often are not as minor as they seem; and, (ii) any violations of the Medicaid eligibility rules can result in loss of taxpayer money to fraud.
Compliance Monitoring and Enforcement
Along with taking steps to establish compliance, NEMT providers must also monitor and enforce compliance on an ongoing basis. Among other things, this means that they must conduct regular audits, and they must update policies and procedures that are outdated or ineffective.
Compliance Documentation
Along with maintaining audit trails, NEMT providers must maintain various other forms of compliance documentation as well. This includes everything from GPS tracking data for their employees’ vehicles to documentation of medical necessity.
Properly Billing Medicaid
All providers that bill Medicaid must do so in accordance with the program’s rules. While these rules are complex, this is not an excuse for non-compliance. NEMT providers must maintain their billing compliance programs to the highest standards, and both intentional and inadvertent billing violations can warrant enforcement action under the False Claims Act.
We Help Whistleblowers Expose NEMT Fraud Under Medicaid
Whistleblowers can report violations of any of the requirements discussed above. Whistleblowers, including citizen journalists, can also report outright fraud (i.e., billing Medicaid for a non-existent NEMT company). Based on the evidence uncovered to date, countless whistleblowers may be eligible to come forward, and our lawyers are available to represent NEMT whistleblowers throughout the process.
Here are three key questions for determining if you may be eligible to report NEMT fraud to the federal government:
1. Do You Have Documentation of Non-Compliance with NEMT Regulations?
To serve as a whistleblower, you must be able to come forward with credible allegations supported by documentation that is not publicly available (or an independent analysis of publicly available data in some cases). Some examples of documentation that can be used to demonstrate non-compliance with NEMT regulations include records that illustrate:
- Billing Medicaid for ineligible transportation services
- Billing Medicaid for NEMT services not provided
- Inadequate (or non-existent) documentation of medical necessity
- Offering or accepting kickbacks from integrated community supports (i.e., social services providers and managed care organizations)
- Upcoding in Medicaid billings
If you have any of these (or any other) forms of documentation in your possession, you should keep them safe until you can share them with your lawyer in strict confidence. If you are aware of documentation on your employer’s computer system or at your employer’s facility, we recommend speaking with a lawyer as your next step.
2. Are You the First to Come Forward?
With only limited exceptions, you must be the first to come forward in order to qualify as a whistleblower under the False Claims Act. This is another important reason to speak with a lawyer as soon as possible if you are thinking about blowing the whistle on NEMT fraud. Again, we represent whistleblowers at no out-of-pocket cost, and we can take action on your behalf immediately if warranted.
3. Are You Prepared to File a Qui Tam Lawsuit Under the False Claims Act?
Exposing NEMT fraud as a whistleblower involves filing a qui tam lawsuit under the False Claims Act. Once you properly file a qui tam lawsuit, the U.S. Department of Justice (DOJ) will review your lawsuit and determine whether further action is warranted. While it is up to you to decide how involved you want to be in the DOJ’s investigation, the more assistance you provide, the greater the chances will be that your lawsuit leads to accountability.
FAQs: Reporting Potential Fraud and Non-Compliance in Medicaid NEMT Operations
How Do I Report NEMT Fraud in New York?
The New York Attorney General’s Office and the federal government both accept reports of NEMT fraud. However, for prospective whistleblowers, contacting the federal government will often be the better approach. The federal government accepts whistleblower complaints involving all forms of Medicaid fraud under the False Claims Act, and whistleblowers who come forward under the False Claims Act are entitled to both strict confidentiality and anti-retaliation protections. False Claims Act whistleblowers are also entitled to financial rewards in some cases.
If you have information about NEMT fraud, our lawyers can help you decide what to do. We will also strictly protect your identity, and we will provide custom-tailored advice based on your individual circumstances.
Can I Be Fired for Reporting My Employer for NEMT Fraud?
Your employer cannot legally fire you for blowing the whistle on NEMT fraud. With that said, to qualify as a whistleblower, you must come forward through the appropriate channels. If you qualify as a whistleblower and your employer fires you illegally, you will be entitled to monetary damages and other appropriate remedies.
Are NEMT Whistleblowers Entitled to a Percentage of the Financial Penalties Recovered?
Whistleblowers who report NEMT fraud under the False Claims Act are entitled to a percentage of the financial penalties recovered in some cases. If the information you provide to the federal government leads to a successful enforcement action, you may be entitled to between 15% and 30% of the amount recovered.
What Should I Do if My Employer is Improperly Billing Medicaid for NEMT Services?
If your employer is improperly billing Medicaid for NEMT services, we strongly recommend speaking with a whistleblower lawyer right away. In this scenario, it is important that you protect yourself, and reporting the fraud to the federal government is unquestionably the right thing to do.
Should I Hire a Lawyer to Help Me Report NEMT Fraud?
Yes, if you believe that you have information about NEMT fraud—whether as an employee, former employee, or citizen journalist—you will want to hire an experienced whistleblower lawyer to help you report the fraud to the federal government. While whistleblower protections (and compensation) are available, there are specific steps you need to take in order to qualify as a whistleblower under federal law.
Speak with a New York NEMT Whistleblower Lawyer at Oberheiden P.C. for Free
If you would like to know more about reporting NEMT fraud to the federal government, we encourage you to contact us promptly. Call 888-680-1745 or contact us online to speak with an experienced New York NEMT whistleblower lawyer in strict confidence today. We represent whistleblowers nationwide.
