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Medicare/Medicaid Whistleblower Exposes Fraud; Lawsuit Pending

Who is A Medicare/Medicaid Whistleblower; What is Medicare/Medicaid Fraud?

Several laws have been passed offering strident protections to individuals blowing the whistle on systemic private insurance fraud. This is because the U.S. Government Accountability Office (GAO) has tagged both Medicare and Medicaid as “high risk” for fraud.

Individuals who currently work or previously worked for a healthcare facility suspected of being complicit in systemic Medicaid and/or Medicare fraud or defense contractors paid by the Federal Government who has knowledge about systemic fraud occurring at their place of employment can become a whistleblower for the fraudulent medical billing of the government.

From the billions recovered last year, whistleblowers can receive an award of up to 30% of what the government recovers for exposing the corruption. Identities of whistleblowers will be concealed for as long as the case progresses.

If you know of systemic fraud in your workplace and believe you can be a whistleblower against Medicare/Medicaid fraud, contact us today for help.

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What Consists as Medicare/Medicaid Fraud?

Medical providers making fraudulent medical claims for Medicare or Medicaid are considered to be engaging in Medicare or Medicaid fraud.

A whistleblower is allowed to sue on behalf of the federal government over fraudulent billing or other fraud, according to the federal False Claims Act which states that “Private citizens who successfully bring qui tam actions may receive a portion of the government’s recovery.”

An act by a medical provider or pharmaceutical company is considered fraudulent when:

  • A claim is submitted for services not rendered
  • Cost reports are inflated
  • A claim is submitted for a service, treatment, or test that was never rendered
  • Research data is falsified to secure a grant
  • There are improper kickbacks
  • A claim is submitted for a service, treatment, or test that is more expensive than the one actually performed
  • Care is refused for high-needs patients
  • Packages are bundled and unbundled for procedures typically performed together
  • Documents are falsified
  • Claims are submitted for medically unnecessary treatments
  • There are improper financial interests
  • There are improper pricing or marketing of drugs

 Deputy Associate Attorney General Stephen Cox stated that “Fraudulent conduct can drive up consumer costs, undermine competition, and in some cases, even put people’s lives at risk. By effectively enforcing the False Claims Act, we protect the taxpayer, we deter bad actors, we protect victims and we level the playing field in the marketplace.”

Medicaid or Medicare fraud renders the offender liable for three times what the government was defrauded, plus civil penalties ranging from $5,000 to $10,000 for each false claim made.

Editor’s note on the Medicare/Medicaid Fraud Class Action Investigation:

This article is crafted to inform you about a potential Medicare/Medicaid Fraud Class Action Lawsuit. If you work or have previously worked for a healthcare facility with which you qualify as a whistleblower, we encourage you to contact us today! 

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If you are considered eligible to be among the category of individuals described in the article above, you may eventually be able to participate in receiving any compensation the court may award.

We’d be happy to help you take a step in the right direction, fight this issue, and better enable you to join in on any potential consumer class action. If interested, please send an email to, find us on Twitter or Facebook, or even connect with us directly on our website! We look forward to hearing from you all.

Similarly, please check out our current list of Class Actions and Class Action Investigations, here.

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