Medicare and Medicaid Fraud

Do you work in the healthcare industry? Do you know of a medical company or provider that bills Medicare or Medicaid for services that were not actually provided? Or maybe they bill for more expensive services than those provided? Or they perform unnecessary procedures? What about someone paying for the referral of patients?

If so, you could be a whistleblower entitled to receive millions of dollars.

Whistleblowers can receive between 15% and 30% of the money recovered from improper billing. Each year, the government recovers billions of dollars and gives a large amount back to the healthcare workers that provide investigative tips on who is submitting fraudulent or inflated claims.

Medicare and Medicaid fraud cost taxpayers billions of dollars each year. Since January of 2009, the Justice Department has recovered more than $24 billion related to fraud against federal health care programs. Medicare and Medicaid fraud can take a number of forms, including:

• Unnecessary Procedures: ordering or providing medical procedures a patient does not need in order to boost profits
• Overbilling: charging for extra services that were not provided
• Upcoding: billing for more expensive medical services than those that were actually performed
• Unbundling: Taking a group of medical procedures that are supposed to be billed together as a single, discounted “package deal” (a bundle) and billing for each individual step separately to rack up a higher total price.
• Kickbacks: Giving someone cash, lavish gifts, or financial perks in exchange for sending Medicare or Medicaid patients (including waived co-pays) to a specific clinic, laboratory, or other medical company.

Contact us today to speak confidentially to a whistleblower attorney – the consult is free.

The FBI estimates that healthcare fraud costs the U.S. government between $51 and $180 billion per year. A single whistleblower can put a stop to hundreds of millions of fraud in a single case and receive a huge financial reward for doing the right thing. If you have information about fraud, we can help you make a compelling whistleblower case, protect your rights, and claim a share of the recovery. Take Action Now!

We focus on representing whistleblowers. Our job is to protect you while building the strongest possible presentation of the fraud for the government. Our support typically includes:

• Confidential case evaluation (what happened, how it ties to government payment, and where the strongest proof may exist)
• Evidence strategy and case development (organizing key documents, timelines, witnesses, and program impact)
• Preparing the required disclosure package for the government and drafting the sealed complaint
• Filing and managing the case under seal and communicating with DOJ attorneys and investigators
• Guiding you through the investigation phase (including interviews and follow-up requests)
• Litigation and resolution strategy (intervention, settlement, or continued prosecution)
• Protection from retaliation and advice on employment-related risk

The goal is simple: assist the government with investigating and understanding the scheme while helping you navigate the process safely and strategically.

Federal law prohibits employers from retaliating against whistleblowers for engaging in protected activities while investigating or reporting FCA violations. Depending on the circumstances, remedies can include reinstatement, back pay, and other relief. If you are worried about your job, your license, or your reputation, we will talk through risk and options—confidentially.

If you would like to confidentially speak to a member of our whistleblower group about potential fraud, please contact us. It costs nothing and only takes a few minutes to see what your information might be worth.

You do not need to have the entire case investigated to speak with an attorney, but the following types of evidence are helpful to supporting your claim:

• Billing and Coding Records: Invoices, superbills, or explanations of benefits (EOBs) showing upcoding (billing for a more expensive service than provided) or unbundling.
• Patient Charts vs. Logs: Discrepancies between actual patient medical records and the electronic health record (EHR) entries or schedules (e.g., billing for patients who weren’t in the office).
• Internal Directives: Emails, memos, or text messages from management instructing staff to hit billing quotas or alter clinical documentation to maximize reimbursement.