Medicare Fraud – How To Report And Get A Reward

Medicare fraud and scams are a crime. The federal government admits that a staggering $60 billion is stolen annually through Medicare scams. Some believe the amount is much more. Here’s what you can do to report Medicare fraud. You might even receive a reward for reporting the criminals.

The False Claims Act pays whistleblowers a reward of between 15 and 25 percent of what the government collects based on your report of Medicare fraud (or Medicaid fraud). The fraud reward can be in the millions of dollars. We explain the very specific rules below.

Examples of Medicare Fraud

Here are some examples from the Medicare website. These are the ones you are most likely to see because Medicare sends you reports when services are billed.

SERVICES NOT PROVIDED.  A healthcare provider that bills Medicare for services or supplies they never gave you. For example, charging you for a visit you never had, or a back brace you never got.

BILLED TWICE FOR SAME SERVICE. A provider that charges Medicare twice for a service or item that you only got once.

FRAUDULENT CLAIM USING YOUR MEDICARE NUMBER. A person who steals your Medicare number or card and uses it to submit fraudulent claims in your name.

A DRUG PLAN NOT APPROVED BY MEDICARE. A company that offers you a Medicare drug plan that Medicare hasn’t approved.

What To Do If You Spot Medicare Fraud

First, the charges may be legitimate. You may want to call your healthcare provider’s office to ask about it. They may be able to help you understand the charges. Or, if they made a billing error, they’ll want to correct it.

If you suspect that Medicare is being charged for an item or service you didn’t get, here is the contact information to report suspected fraud or abuse.

You have Original Medicare (just Parts A and/or B) – Call 1-800-MEDICARE (1-800-633-4227). Or report online to the Office of the Inspector general. File a Medicare Fraud Report.

If you have Medicare Advantage (Part C) or Medicare drug plan coverage (Part D) – Call 1-800-MEDICARE (1-800-633-4227). Or call The Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX (1-877-772-3379).

You can submit by US mail to Qlarant – 28464 Marlboro Avenue – Easton, MD 21601
Attn: I-MEDIC

What Information Will You Need?

When you call Medicare have this information ready:

• Your name and Medicare Number.
• The name of the provider that you’re reporting, along with any identifying information you may have.
• The service or item you’re questioning and when you supposedly got it.
• The amount that Medicare approved and paid.
• The date on your Medicare Summary Notice, health or drug plan’s Explanation of Benefits, or claim.

Can You Get A Reward for Reporting Fraud? Yes If It’s Widespread

You cannot get a reward for calling a Medicare hotline.

To be eligible for a reward, you must hire an attorney. The fraud must be widespread. It may involve a hospital or large medical practice cheating many people.

The lawyer will need to file what is called a qui tam application under the False Claims Act. You can find lawyers looking for Medicare cases by doing a Google search.

Ask the attorney to review your allegations in strict confidence and without charge. The attorney will normally charge a contingency fee. Simply, they will get a portion of any reward you might receive.

To get a reward for reporting Medicare fraud, you will want to show widespread fraud. Not a single or isolated instance. Any reward is based upon how much money the government collects back from the entity that is defrauding Medicare or Medicaid.

According to fraud lawyers, whistleblowers more likely to receive rewards have worked for the hospital or healthcare provider who committed the fraud. They have knowledge of the fraud scheme, and can actually receive a reward even if they were asked to participate in defrauding Medicare or Medicaid.

The government pays huge monetary rewards when the whistleblower has inside information that proves the Medicare or Medicaid fraud.

Examples of Two Large Cases Reported

Cases can be large. In August 2015, a court sentenced the former owner and operator of multiple HIV/AIDS Clinics in New York City, to 87 months in prison. He was charged with orchestrating a scheme to defraud Medicare out of more than $31 million.

In January 2020, a Texas Rheumatologist was found guilty for his role in Medicare fraudulent activities. He falsely diagnosed patients with life-long diseases and treated them with unnecessary treatment. As found by the court, a rough estimation of $325 million was obtained in this health care fraud scheme.

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