Medicare Advantage Fraud Lawyer for Medicare Advantage Plan Insurance Fraud
If you are aware of Medicare Advantage Fraud, we urge you to call our firm and Medicare Fraud Advantage Lawyer Steve Teller to learn about your options of potentially receiving large compensation for exposing fraud.
Acting on reports from whistleblowers, the Department of Justice has launched investigations to expose fraudulent overbilling into Medicare Advantage plan’s largest insurance providers, including (but not limited to):
- United Health Group
- CVS Health
- Elevance Health
- Kaiser Permanente
- Blue Cross Blue Shield of Michigan
- Scan Group
According to the Inspector General, the majority of the top ten providers overbilled the Centers for Medicare & Medicaid Services (“CMS”), resulting in billions of dollars in fraudulently obtained reimbursements. In many cases, these insurers incentivized physicians and medical personnel to add illnesses to medical records to inflate risk factors and obtain additional reimbursements.
If you are aware of individuals or companies that have illegally benefited from such practices, please call our office or complete the contact form below to schedule a free consultation with experienced Medicare Advantage Fraud attorney Steve Teller. Steve has helped whistleblowers expose millions of dollars in fraudulent activities against the government and has obtained significant compensation for the whistleblowers for exposing Medicare fraud.
At Teller Law, we represent brave whistleblowers on a contingency-fee basis, meaning that we are only entitled to a fee if compensation is recovered. We also advance all litigation expenses while a case is ongoing.
Can I Get a Reward for Exposing Medicare Advantage Fraud?
Yes. Under the False Claims Act, a whistleblower is entitled to a reward of between 15% to 25% of the recovered proceeds for confidentially reporting Medicare Advantage plan fraud.
What is Medicare Advantage Insurance?
Medicare Advantage (also referred to as Medicare Part C) is an alternative to traditional Medicare. Under the Medicare Advantage program, private insurance companies offer Medicare-approved plans that bundle together healthcare services into a single, comprehensive package. For example, a private Medicare Advantage plan may offer hospital coverage, doctor and outpatient services, and prescription drug coverage; whereas, under traditional Medicare, enrollment in Medicare Part A, Part B, and Part D would be required to obtain the same coverage.
The program was originally designed by Congress over two decades ago to encourage healthcare providers to find innovative ways to provide a higher standard of care at a lower cost. The system offers risk adjustment payments that are calculated based on each member’s diagnoses and risk score. The risk score is based on factors such as:
- Disability status
- Institutional status
- Health status
Under this calculation, sicker individuals are assigned a higher risk score which results in increased risk adjustment payments from the government. For example, the federal government pays insurance companies a set amount for each Medicare Advantage enrollee, but instead of paying the baseline amount, they may pay thousands in additional funding if an individual has a significant illness and risk factors.
To exploit this financial loophole, insurance companies have implemented elaborate systems to pad medical records with inflated diagnoses to obtain higher reimbursements. Consequently, according to the New York Times, “a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.”
How Are Large Insurance Companies Allegedly Defrauding the Medicare Advantage Program?
In lawsuits against unscrupulous insurers, the Department of Justice elaborated on many of the strategies used to defraud the government and undermine the Medicare Advantage program, including:
- Urging doctors to add additional illnesses to the medical records of patients that hadn’t been seen in weeks;
- Providing champagne or financial bonuses for physicians who added significant diagnoses codes;
- Reimbursing more to physicians who stated their patients were sicker;
- Mining old medical records to find unrelated illnesses,
- Failing to correct false or improper diagnoses and related reimbursement claims;
- Creating false documentation; and
- Submitting risk adjustment claims that aren’t supported by proper medical documentation.
In many of these cases, the insurers developed elaborate schemes to make their patients appear as ill as possible, often without providing any additional treatment. According to federal audits, eight of the ten largest Medicare Advantage Insurance companies have submitted inflated bills, and four out of the five biggest companies have faced federal lawsuits alleging fraudulent efforts to overdiagnose their customers.
How Can Private Citizens Expose Medicare Advantage Plan Fraud?
Under the False Claims Act, whistleblowers (also referred to as “relators”) can file civil lawsuits to hold parties committing fraud against the government accountable and assist in recovering fraudulently-obtained funding. The Department of Justice then has the option to intervene and take over responsibility for investigating and prosecuting the case.
How Much Does Medicare Advantage Fraud Cost the US Government?
It is estimated that Medicare Advantage plan fraud leads to over $12 billion in overpayments annually. Based on this rampant abuse, millions of dollars in compensation could be available to whistleblowers who help expose fraudulent healthcare schemes.
What You Should Know About Exposing Medicare Advantage Billing Fraud
If you are aware of Medicare Advantage fraud, you should know that:
- We offer a free, no-obligation consultation during which Medicare Advantage plan fraud lawyer Stephen Teller can listen to the facts of your case and explain your legal options for exposing misconduct through a whistleblower claim.
- We represent whistleblowers on a contingency fee basis, meaning that we are only entitled to a legal fee if money is recovered.
- We advance all litigation costs on behalf of clients (which are typically fully paid by a whistleblower reward).
- Whistleblowers are generally entitled to 15%-25% of the amount recovered by the federal government. This can amount to millions in large-scale healthcare fraud cases.
Can I Be Fired or Retaliated Against for Reporting Medicare Advantage Program Overbilling by My Employ
Whistleblowers are protected by law against retaliation, as they play an integral role in helping the government expose illegal conduer?ct that would otherwise be unlikely to be discovered.
Whistleblower retaliation occurs when a company takes an adverse job action against an employee (such as being fired, demoted, harassed, or subjected to other negative consequences) for engaging in a protected activity, such as reporting a company for:
- Medicare Advantage fraud
- Risk adjustment fraud
- Other forms of healthcare fraud
If a company retaliates against any employee, whistleblower retaliation attorney Stephen Teller is available to represent individuals in a separate cause of action against the employer, which could lead to substantial additional compensation. This means that if you are fired for exposing fraud, not only are you eligible to receive a portion of the fraud payments that are recovered, you will also have a claim against your employer for wrongful termination.
Call Medicare Advantage Fraud Attorney Stephen Teller for a Free Consultation
The government is highly reliant on private whistleblowers to expose Medicare schemes aimed at defrauding the government. If you have knowledge of a physician, insurer, or healthcare company that committed Medicare Advantage fraud, we invite you to call our office at 206-324-8969 or fill out the contact form below to schedule a free consultation with experienced Medicare fraud lawyer Stephen Teller.
During the free, initially confidential consultation, as a Medicare Advantage fraud attorney, Steve can answer your questions and help determine if you may have grounds to pursue a False Claims Act action.
 What is Medicare Advantage?, AARP, What Is Medicare Advantage, and Is It Right for You? (aarp.org).
 The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions, The New York Times, https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html.