Medicare Fraud & Medicaid Fraud – Learn About the Compensation that May Be Payable for Reporting Fraud Against the US Government

Medicare and Medicaid Fraud are not victimless crimes.  Each year, billions of dollars in taxpayer money is fraudulently paid to physicians, hospitals, clinics, and medical offices for medical services, prescriptions, and equipment as part of the federal government’s Medicare and Medicaid programs. This is your money and my money.  Fortunately, under the False Claims Act, whistleblowers are encouraged to expose fraud through potential compensation opportunities, which ultimately serves to reduce fraud.

As a Seattle Medicare Fraud lawyer & Medicaid Fraud attorney, I am available to represent whistleblowers not only in Seattle, but throughout the State of Washington and the United States.  If you do not reside in the Seattle area, I can still represent you.  If you do reside here, but know of a fraud perpetrated against the US government or Washington State government anywhere in the country or the world, I can probably help.

Understanding Medicare and Medicaid Fraud

While most Medicare and Medicaid claims are submitted for legitimate medical services, unfortunately a disturbingly high percentage of these Medicare and Medicaid claims are fraudulent, such as:  Patients who were never seen.  Procedures that were never performed.  Overbilling and making intentional use of incorrect procedure codes.

In the end, Medicare and Medicaid fraud harms all of us.  The Medicare/Medicaid system is constrained or limited by fraud because fraudulent payments cannot otherwise be used to pay for medical treatment genuinely needed.

As a Seattle whistleblower lawyer, my goal is to help clients expose fraud, and to help them obtain compensation for their courageous role in helping federal and state governments recover money under the False Claims Act and Qui Tam provisions.

If you are aware of a case of Medicare or Medicaid fraud, I would invite you to call me to learn about the compensation to which you may be entitled.  I offer a free consultation, and I only receive a fee if compensation is recovered.

How Much Does Illegal Fraudulent Claims Cost US Taxpayers?

The federal agency tasked with administering Medicare and Medicaid – the Centers for Medicare and Medicaid Services – has reported that about $60 billion of American taxpayer money was paid for fraudulent claims in a recent year, according to ABC News.  This amount represents an astounding 10% of the total budget for Medicare and Medicaid for that year.  In other words, $1 of every $10 paid by Medicare and Medicaid is paid for a fraudulent claim.

For example, the U.S. Government Accountability Office (GAO) conducted an audit of the Medicare’s list of health care providers and discovered that more than 23,000 of the mailing addresses that were supposedly affiliated with clinics and hospitals turned out to be fraudulent, and sometimes were for vacant lots, hamburger stands, and mailbox stores, according to a Congressional report.

The Origins of the False Claims Act

The False Claims Act was enacted during the Lincoln presidency, which is why it is sometimes known as the “Lincoln Law.”  Under the False Claims Act, whistleblowers are entitled to file lawsuits against individuals, companies, and entities perpetrating fraud against the federal government.  To encourage such cases, the False Claims Act provides for compensation to be paid to such whistleblowers in the event of a successful outcome based upon a percentage of compensation that is ultimately recovered.

Types of Medicare & Medicaid Fraud

Medicare and Medicaid fraud consists of schemes running from those that are relatively simple (such as “upcoding” billing for procedures) to those that are complex (and which may involve fake patients and a wide variety of participants).

Common Medicare and Medicaid fraud cases often consist of:

  • Billing for services never performed;
  • Billing for products and supplies never delivered;
  • Misrepresenting services rendered, such as “upcoding” (intentionally billing for services using the wrong billing code so that the services will be charged at a higher rate)
  • Billing for services that were not medically necessary;
  • Duplicate billing;
  • Split billing (i.e. billing for multiple medical procedures over a period of time when all treatment actually occurred during one visit);
  • Admitting patients when doing so was not medically necessary
  • Billing for provider services “incident to” a physician who is not present in the facility at the time of service.

Some Medicare and Medicaid schemes involve multiple participants.  As an example, “patients” who were never injured may get paid for “seeing” chiropractors.  The patients in fact receive no medical treatment and were never seen, but the chiropractors nonetheless submit bills to the government for visits and treatment.  These schemes may also include third parties who recruit and pay such “patients”, and who receive a payment from the chiropractors for their illegal recruiting efforts.

The fact is, the more patients that are seen, and the more procedures that are ordered, the more compensation that providers receive.  Performing unnecessary procedures (and claiming that procedures were performed when in fact this was not the case), can be tempting, as it can result in substantial income to a provider.

Stark and Other Federal Laws 

Additionally, there are other federal laws, such as the Stark law, which prohibit fraud.  Stark laws generally prohibit physicians from prescribing treatments and services from other providers where the physician will receive a kickback or other compensation as the result of such prescription.  In addition to these prescriptions (which may even be for legitimate services), physicians may also attempt to benefit financially from the enormous drug problem in the US by prescribing drugs (such as Oxycontin) to patients who do not need these drugs.  The patients then will re-sell these drugs on the streets, and pay the physician a kickback for writing the prescription. 

Call Today for a Free Consultation to Learn How a Case for Medicare & Medicaid Fraud May be Brought, and the Compensation to Which You May be Entitled

The foregoing are only some examples of Medicare and Medicaid fraud.  Many other schemes are actively being practiced.

Once I learn about your case, I can explain the process for bringing a Medicare Fraud case or Medicaid Fraud case, and the compensation to which you may be entitled if a jury award or settlement results.