Medicare & Medicaid Fraud

Medicare and Medicaid are government healthcare programs that cost over $1 trillion each year. Estimates of fraudulent healthcare billing, both private and public, are between 3% and 10% of total health care expenditures. Attorney General Eric Holder stated, “Every year we lose tens of billions of dollars in Medicare and Medicaid funds to fraud. Those billions represent healthcare dollars that could be spent on medicine, elder care, or emergency room visits, but instead are wasted on greed.” As the population ages and people live longer the demand for Medicare and Medicaid services will continue to increase. This demand unfortunately has many trying to take advantage of the enormity of this system. Given the number of patients, healthcare providers and services, the government alone cannot combat Medicare and Medicaid fraud. Frauds in this field range from inflating costs on Medicare reports to research grant fraud, but all of them hurt this vital system and take away from patient care.

Whistleblowers have a unique ability to help root out these frauds with their unique perspective and potential insider information. When individuals or companies take advantage of Medicare and Medicaid it puts a burden on these systems and in turn on each one of us who help to support it.

Whistleblower Justice Network has helped many whistleblowers build cases in the Healthcare industry. We have walked in your shoes and can provide an expert perspective as well as the right legal counsel for your unique case.

Medicare & Medicaid Fraud Examples

  • Upcoding; the practice of billing for a healthcare treatment or service which is more costly than the one provided which allows the healthcare provider to receive more money than they should
  • Lack of medical necessity for procedures or services
  • False certification of a healthcare contract
  • Bundling or unbundling procedures; preforming a number of grouped procedures together can qualify a healthcare provider for specials reimbursement rates; or unbundling procedures and billing for each separately can increase the reimbursement rate.
  • Research grant fraud can include falsifying an application, using grant money for unrelated research, or falsifying data.
  • Inflating Medicare Cost Reports by reporting false information to increase reimbursement.

Latest Medicare and Medicaid Fraud News

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 Our case analysts help whistleblowers fully understand, organize and refine the information that they have in their possession. Complemented by our understanding of a wide array of financial fraud, Whistleblower Justice Network will help you make your best case, determine the most appropriate law firm to handle your case, and ensure that your case receives the attention it deserves every step of the way.

Contact us today and let us explain how we work with whistleblowers in pursuit of justice against those who defraud the U.S. government, and each of us as its citizens. Working with whistleblowers, and filing whistleblower actions is all we do as a company. We are whistleblowers ourselves, and we love what we do.  Our clients and Whistleblower Justice Network, together we make a difference.