Do you have knowledge about attempts to defraud Medicare, Medicaid, or other government healthcare programs? If you work in a hospital, doctor’s office, as an insurance adjustor, in a nursing home, or in the pharmaceutical industry, you may have an insider’s perspective into a federal crime that costs taxpayers billions of dollars each year.
The National Health Care Anti-Fraud Association estimates that healthcare fraud in the United States costs around $68 billion annually. As a percentage of overall spending, this amount comes to about three percent of the United States’ $2.26 trillion healthcare budget.
If this estimate seems high, other sources estimate the amount of healthcare waste and fraud annually lands at about $230 billion, or at about 10 percent of overall US healthcare spending. Out of this, attempts to defraud Medicare, Medicaid, and other publicly funded healthcare programs account for a high percentage of loss annually.
Medicare Fraud in Chicago
In 2018, the Department of Justice launched the largest-yet healthcare fraud enforcement action in American history, focused on Chicago. This far-reaching enforcement taken by the Medicare Fraud Strike Force – a component of the Department of Justice – involved over 600 defendants and approximately $2 billion in false claims.
According to the Attorney General, “Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer.” False claims not only draw down taxpayers’ funds, but also make the system less effective and more expensive for those who need to rely on it.
Examples of Medicare False Claims in Chicago
Because of the high risk of Medicare and Medicaid fraud, the Centers for Medicare and Medicaid Services (CMS) have released a non-comprehensive set of guidelines on what to look out for. Medicare fraud may look like:
- Billing for unnecessary services
- Billing for services that were never provided to the patient
- “Upcoding,” or billing for more expensive services than the ones rendered
- “Unbundling,” or billing for multiple procedures separately that could be billed together for less
- Collusion, or knowingly collaborating to file false claims for reimbursement
- Receiving kickbacks, often between medical providers and pharmaceutical companies who enjoy a financial relationship when it comes to offering recommendations and patient referrals
What to Do If You Suspect Medicare Fraud
If you have information about Medicare fraud, speak to a qualified Chicago lawyer today to discuss what kinds of evidence can launch a Department of Justice investigation and what kinds of workplace material you should legally leave alone. Speaking up is the right thing to do, and coming forward sooner rather than later can have important effects. For example, acting fast can preserve evidence that would otherwise be destroyed, conserve taxpayers’ money, protect vulnerable patients, and ensure that you yourself do not become implicated in any ongoing crimes.
Speak to a Medicare Fraud Lawyer in Chicago
Qui tam law involves false claims, average citizens, and the government. In a qui tam case, a third party (known as a whistleblower or “relator”) brings information about fraud or waste in a civil lawsuit on behalf of the government. The most common example of this is healthcare fraud, such as improper Medicare or Medicaid payments.
Whistleblowers in qui tam cases are eligible to receive up to 30 percent of the government’s overall payout in a successful qui tam case, under the False Claims Act.
False Claims Act
The False Claims Act, in addition to offering up to 30 percent of the government’s payout as an incentive for whistleblowers, also sets guidelines for financial payouts and penalties for false claims. According to the most recent iteration of the law, violators can be held subject to treble (3x) damages for each false claim. False claims are also punishable by individual financial penalties for each violation.
Whistleblower Protections in Chicago
The False Claims Act guarantees certain federal protections for whistleblowers, but Illinois also has a state False Claims Act. The Illinois False Claims Act offers at least 15 percent, but not more than 25 percent, of the total award to whistleblowers in state qui tam cases, as long as the plaintiff has “substantially contributed” to the success of the case.
The Illinois False Claims Act also offers protections and relief for whistleblowers in the event that they may be discriminated against by their employers for coming forward. According to state law, examples of prohibited retaliation include:
- Discharge or firing
- Demotion or reduction of pay
- Suspension
- Threats, harassment, or any other manner of discrimination because of lawful acts done by the employee or others associated with them in an attempt to report wrongdoing
If you have been discriminated against in any of these ways or others by your employer for attempting to report Medicare or Medicaid fraud, speak to an attorney in Chicago today. There may be legal recourse available to you. State law provides options for reinstatement, two times the amount of backpay, interest on the backpay to which you may be owed, and other compensation in cases of whistleblower discrimination.
Call a Chicago Medicare Fraud Attorney Today
Speaking up about Medicare fraud is the right thing to do. If you have information that could lead to a successful case, you may be eligible to receive financial compensation, while keeping your employment and privacy protected.
Qui tam law can be complicated, and finding the right attorney is vital. The team at Tycko & Zavareei LLP has successfully settled scores of whistleblower cases, resulting in multi-million dollar settlements. Reach out to our Medicare fraud lawyers in Chicago today for a complimentary, confidential legal consultation. We can discuss the facts of the possible case and decide what will be in your best interests going forward.
