Reporting kickback fraud under Medicare
This article shows you how to get a reward for reporting Medicare kickback fraud or Medicaid kickback fraud against the federal or state government.
About 10% of spending by the federal and state governments for healthcare costs under Medicare and Medicaid is paid for fraudulent billings. One scheme by Medicare providers is by paying kickbacks to healthcare providers for using their drugs, products or services. Illegal kickbacks are also prevalent in state Medicaid programs.
When Medicare or Medicaid providers receive or pay kickbacks for referrals or to use certain drugs, devices or products and services, we all suffer. Kickbacks destroy our confidence in our medical and healthcare system, and result in overcharges to the government programs.
The good news is that the government is paying large whistleblower rewards for reporting kickback fraud schemes affecting Medicare or Medicaid.
Tips for reporting kickback fraud
This article answers how to report kickback schemes that affect Medicare or Medicaid. It also shows how to apply for a whistleblower reward for reporting Medicare kickback fraud.
First, you cannot receive a reward for calling a hotline to report kickback fraud. To get a whistleblower reward for reporting kickback fraud requires using a lawyer filing a qui tam suit under the False Claims Act. Your lawyer will use a contingency fee, which means he gets a percentage of any whistleblower reward. He must scrupulously follow the procedures in the reward program for reporting Medicare kickback fraud.
Next, your allegations must be specific and detailed about the kickbacks. The government turns down three out of four reward claims, so it’s key that you ask an experienced attorney to review your case in confidence and give you candid advice about whether you have the right type of kickback allegations to receive a reward.
How much reward for reporting kickbacks to or by Medicare providers
The amount of a whistleblower reward is a percentage of the amount of money Medicare or Medicaid recovers based on your kickback allegations. The amount the Medicare provider must repay, however, is often far more than the amount of the kickbacks. It can include the total amount of the Medicare billings.
In one Medicare kickback fraud settlement, a large pharmaceutical company paid the government $875 million to settle allegations that it paid kickbacks to doctors to prescribe one of their drugs. The whistleblower received millions of dollars for reporting the Medicare kickback scheme.
Examples of Medicare kickback fraud
Everyone knows that paying kickbacks is illegal. Sadly, kickbacks are prevalent in Medicare and Medicaid. For instance, a doctor should decide what drugs to prescribe or operation to perform without regard to whether he gets a kickback from a company for using their product. How would you like it if you knew that a doctor receives $100 kickback if he uses a pacemaker from company X? You might wonder if you really need a pacemaker and would be concerned that it clouded his judgment. Because of the inherent problems with kickbacks, they are illegal and considered Medicare fraud regardless of whether the Medicare patient ultimately needed that drug or device.
Kickback scheme include paying doctors for using certain brands of durable medical equipment or prescribing certain drugs. Kickback schemes also occur when a doctor or hospital orders certain lab tests or blood work. Kickback fraud also exists when a doctor, hospital, clinic or nursing home, refers patients to other healthcare providers.
Because kickbacks are unlawful and also carry criminal fines and even prison sentences, most kickbacks are disguised so that they are not obvious. For instance, a doctor might get offered a consulting contract to provide consulting services. The form of a kickback might also be disquieted as a training contract, where the doctor is asked to fly to Hawaii for two weeks at an expensive hotel to speak at a meeting for one hour on the benefits of using that company’s drug, device or healthcare product.
The format of a kickback is limited only by imagination. What is really going on is that the Medicare provider is getting something of value with an expectation that it will influence his decision to use their product, drug or device.
Because Medicare or Medicaid cannot detect a kickback without the help of a whistleblower, it is offering large rewards for you to step forward and report kickbacks.
How to report Medicare kickback fraud
Mr. Hesch gained valuable experience investigating fraud, including Medicare kickback fraud, while working 15 years at the Civil Fraud Section of the U.S. Department of Justice in Washington, D.C.
The link at the bottom of the page below “Do I have a case” shows you how to ask Mr. Hesch to review your potential Medicare kickback fraud case and how to get a reward. The link at the bottom of the page below “Report Fraud” has more information regarding how to get a reward for reporting kickback fraud affecting Medicare or Medicaid.
The rest of this website and books by Mr. Hesch contain more details about reporting Medicare kickback fraudd obtaining a whistleblower reward.
Click on this link to read this article in pdf format: Report Medicare kickback fraud and get a whistleblower reward PDF version