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What is a Medicare Whistleblower?

Daphne Mallory
Daphne Mallory

A Medicare whistleblower is a person who reports Medicare fraud. Medicare is a federal health care benefit available to seniors in the United States. Medicare fraud occurs when medical institutions and health care providers collect reimbursement for services and medical care by fraud, including double billing, false coding, and intentionally charging for services that patients did not receive. Patients and employers are often whistleblowers, and there are whistleblower laws to protect them and encourage the public to bring forward knowledge of businesses and others that are defrauding the federal government. A Medicare whistleblower lawyer represents a whistle blower in Medicare fraud cases, which are referred to as qui tam lawsuits.

Medicare is funded by the taxpayers, and fraud that is left unexposed often costs the taxpayers billions of dollars each year. Some medical providers defraud Medicare because they are guaranteed reimbursement and a cash flow. For example, hospices around the United States have been caught filing Medicare claims for patients who were not eligible to receive benefits as a means of obtaining cash to fund the hospices’ operations. These businesses often defraud Medicare because seniors may not be able to afford their services otherwise. Medicare whistleblowers working for these companies often become aware of the fraud and report it and join the government in whistleblower lawsuits.

The False Claims Act protects Medicare fraud whistleblowers from being fired or demoted in retaliation.
The False Claims Act protects Medicare fraud whistleblowers from being fired or demoted in retaliation.

Under federal laws, an individual involved in fraud reporting is entitled to a whistleblower reward if the government is able to recover proceeds in a lawsuit or if the individual files a lawsuit. The False Claims Act outlines the rewards available and specifies that the whistleblower has to be the original source who leads to a successful lawsuit exposing the fraud. The government may or may not decide to proceed with legal action. If it does, the whistleblower is often able to receive between 10 and 25 percent of the proceeds awarded to the government. The Medicare whistleblower can bring a qui tam lawsuit on the government’s behalf and can often recover 25 to 30 percent of what the civil court determines is reasonable for damages. The percentages also pertain to any settlement reached prior to the conclusion of the trial.

Unexposed Medicare fraud often costs taxpayers billions of dollars each year.
Unexposed Medicare fraud often costs taxpayers billions of dollars each year.

The False Claims Act also provides protection to the whistleblowers against retaliatory acts by those who defraud Medicare. For example, employers will be liable to compensate the Medicare whistleblower if he or she is demoted, fired, or suspended as a result of reporting the fraud. The employer would have to pay twice as much as the back pay that the employee earned, as well as special damages.

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    • The False Claims Act protects Medicare fraud whistleblowers from being fired or demoted in retaliation.
      By: apops
      The False Claims Act protects Medicare fraud whistleblowers from being fired or demoted in retaliation.
    • Unexposed Medicare fraud often costs taxpayers billions of dollars each year.
      By: Kenishirotie
      Unexposed Medicare fraud often costs taxpayers billions of dollars each year.
    • Medicare is a federally administered program that provides health insurance for people over the age of 65.
      By: Monkey Business
      Medicare is a federally administered program that provides health insurance for people over the age of 65.
    • The Medicare program helps cover the cost of prescription drugs for elderly individuals.
      By: nyul
      The Medicare program helps cover the cost of prescription drugs for elderly individuals.