How are Medicare whistleblower rewards paid?

A common question by whistleblowers wanting to report Medicare fraud is how are Medicare whistleblower rewards paid? This article addresses how a whistleblower reports Medicare fraud to receive a whistleblower reward and how Medicare rewards are paid. It lists the steps you must take to be eligible. If you miss even one of them, you won’t get a Medicare whistleblower reward.

Why become a Medicare Whistleblower?

Medicare fraud is hurting healthcare because there is less money to help those actually needing Medicare. If you know of significant Medicare fraud, it’s your duty to report it. You should also explore seeking a whistleblower reward for reporting Medicare for several good reasons. First, by law you are entitled to the reward, if you follow the proper steps in reporting it. Second, if you uncover significant Medicare fraud, you should be compensated because it takes a lot of time, effort and energy to prove it. Third, and perhaps most significantly, the government will take your allegations more serious and assign a Department of Justice (DOJ) attorney to investigate your case only if you hire an attorney and seek a reward. By law, DOJ must investigate all whistleblower reward claims filed by attorneys on behalf of clients. If you simply call a hotline, chances are DOJ will never learn of the allegations. That’s also why choosing your attorney is an important factor, i.e. did they work for DOJ or have won Medicare whistleblower reward cases in the past, because they will be the one working directly with DOJ attorneys investigating and proving the fraud.

How are Medicare whistleblower rewards paid?

The only way to receive a Medicare whistleblower reward is to hire an attorney (on a contingency basis) to file a complaint under the False Claims Act (FCA) and allege in detail the Medicare fraud. If you are the first person to properly file for a Medicare whistleblower reward, you are eligible for a reward of between 15 and 30 percent of what the government collects based on your report of Medicare fraud allegations.

Steps to getting paid a Medicare whistleblower reward

Here are the four key steps for a Medicare whistleblower reward to be paid:

1. To receive a Medicare whistleblower reward, you must actually hire an attorney to file a FCA lawsuit against the hospital or healthcare provider that is committing Medicare fraud or Medicaid fraud. To convince the government to take a Medicare fraud case requires detailed and specific evidence that the healthcare provider was committing fraud against Medicare or Medicaid. It is not enough to report fraud to a hotline or have a general knowledge of Medicare or Medicaid fraud. Usually, rewards are paid to whistleblowers who worked for the hospital or healthcare provider who committed the fraud because they have knowledge of the fraud scheme, and 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. The good news is that Medicare whistleblower attorneys take cases on a contingency basis, which means they cover all the costs and take a portion of any reward that the Government pays. The information you provide to a prospective attorney is also privileged and cannot be shared by the attorney or used for any other purpose even if you end up not hiring that attorney or filing for a reward. (Click here to have Mr. Hesch review your case and determine if he believes you have the right type of a case to receive a reward and if he can represent you before DOJ.)

2. Your attorney must be the first one to file a qualifying whistleblower reward application. By law, DOJ may only pay one whistleblower a reward for a single fraud scheme. It is paid to the first whistleblower that properly files a whistleblower complaint under the False Claims Act. (Of course, if the defendant is committing several types of fraud, such as upcoding and kickbacks, the law allows rewards paid to separate whistleblowers for each fraud scheme.) Thus, you should not delay in contacting an experienced Medicare fraud whistleblower attorney in complete confidence to evaluate your potential Medicare fraud case.

3. The Medicare fraud allegations must not already be the subject of a news media article or certain other public forums, unless the whistleblower is considered an “original source” of the public disclosure. In short, if the media or certain government reports already contain the allegations, there is little need to pay a reward. However, there are exceptions to this rule, such as when you have “knowledge that is independent of and materially adds to the publicly disclosed allegations or transactions.” You will need the help of an experienced Medicare fraud attorney to determine if you meet this exception.

4. The Defendant must pay the government money to settle or resolve the Medicare fraud allegations. Again, the Medicare whistleblower reward is a portion of the money the wrongdoer repays. By law, the reward can only be between 15 and 30 percent of the funds actually recovered. Your attorney will have to negotiate the exact amount, but the reward is based on the money returned to Medicare. For instance, if a hospital repays $10 million, the reward will be between $1.5 million and $3 million. Conversely, if DOJ does not collect any funds, there is no reward even if the company stops committing future fraud. The key to obtaining a significant Medicare fraud whistleblower reward is to have proof of widespread Medicare fraud. It is not usually worth your time to report fraud if you do not have evidence that the entity committed fraud against Medicare on a large scale, and many law firms (such as Mr. Hesch) have a $5 million fraud threshold to ensure that the rewards outweigh the risks.

Mr. Hesch would be pleased to review your information in complete confidence and help you determine if you have the right kind of information to receive a significant Medicare whistleblower reward.

Click on this link “Do I have a case” to have Mr. Hesch review your potential whistleblower reward case for Medicare fraud. Click on this link to see examples of Medicare whistleblower fraud cases Mr. Hesch worked on while working for the Department of Justice for 15 years and now in private practice exclusively representing whistleblowers (totaling over $1.7 billion).