What is health care and Medicaid / Medicare fraud?

Health care fraud involves the filing of dishonest heath care claims in order to turn a profit. Examples of practitioner schemes include a health care provider who bills Medicare for services that were not performed or were unnecessary, double-billing, billing for a non-covered service as a covered service, modifying medical records, intentionally reporting incorrect diagnoses in order to maximize payment, and prescribing unnecessary treatment.

How do so-called Whistleblower laws apply to health care fraud?

The False Claims Act holds liable those who knowingly submit, or cause another entity or person to submit false claims for payment of government funds. Those found responsible for fraud are liable for three times the government’s damages plus civil penalties of $5,500 to $11,000 per false claim. Whistleblower provisions included in the False Claims Act allow citizens with evidence of fraud against government contractors and programs to sue, on behalf of the government, to recover the stolen funds. The whistleblower is then eligible to receive a portion of the recovered funds, usually between 15 and 25 percent.

In addition to the federal False Claims Act, many states also have False Claims Acts that work in a similar fashion.

There also is a part of the False Claims Act that is known as the “whistleblower protection” provision. This provision ensures that if you are fired, demoted, suspended, threatened or discriminated against in any other way by an employer as a result of your filing a report of fraud, that you will be reinstated to your former position. This includes receiving any seniority that may have been affected, as well as back pay, interest and other compensation that may be due as a result of damages or losses you suffered as a result of filing a claim.

What can I do?

If you feel you have a claim, our attorneys would like to talk to you. You may be entitled to compensation. Contact us today for a free, no-obligation legal consultation.


We're here to help!

We live by our creed of "helping those who need it most" and have helped thousands of clients get the justice they desperately needed and deserved. If you feel you have a case or just have questions please contact us for a free consultation. There is no risk and no fees unless we win for you.

Fields marked    may be required for submission.
  1. I'm an attorney

Whistleblower helps Mississippi win record False...

A Mississippi mental health facility has agreed to pay the U.S. government and the state’s Medicaid...

Whistleblowers expose illegal drug recycling in Penn...

The whistleblower complaints alleged that Med-Fast violated the False Claims Act by distributing and...

Whistleblower action recovers $1.4 million from...

The whistleblower lawsuit alleged that Dental Dreams improperly billed the Massachusetts Medicaid...

$55 Million Health Care Fraud Scheme Discovered at Two...

Brooklyn, New York, based medical clinics Prime Care on the Bay (Prime Care) and Bensonhurst Mega...

National hospital chain agrees to pay $32.7 million to...

Vibra Healthcare LLC (Vibra), a national hospital chain headquartered in Pennsylvania, agreed to pay...
Whistleblower

Medical device manufacturer pays $18 million to...

This July, the Department of Justice (DOJ) announced that a subsidiary of Johnson & Johnson agreed to...

Hospice providers pay $18 million to resolve alleged...

Recently, the Department of Justice announced Evercare Hospice and Palliative Care have agreed to pay...

Government recovers $900 million in the largest ever...

According to the Department of Justice (DOJ), more than 300 people have been charged with Medicare fraud...

Cardiologist settles False Claims Act allegations for...

Dr. Asad Qamar and his practice, the Institute of Cardiovascular Excellence (collectively known as...

Government targets Ambulance Transport Fraud

Last year Medicare paid more than $50 million in potentially improper bills from ambulance companies....

Health Care Companies Agree to Pay $20.9 Million to...

Hollister Inc. and Byram Healthcare Centers Inc. have agreed to pay $20.9 million to resolve kickback...

The Anti-Kickback Statute and the False Claims Act...

Olympus Corp. of Americas, a medical device company, will pay $623.02 million to settle criminal charges...

Highly recommended

I would highly recommend this law firm to handle any of your legal needs.

—Sandy