Why is Medicare Fraud Such a Problem Today?

Today, health care fraud is ever-prevalent and continues to prove expansive. Medicare fraud encompasses many different types of activity, from billing for services that were not performed to miscoding. Consequently, the government relies heavily on whistleblowers and rewards them significantly for reporting fraud. This requires the skill of an experienced medicare whistleblower attorney to guide people through a claim to ensure that individuals and entities are held accountable.

How Medicare Works

Because Medicare is a vast government program, it must rely on many private companies to help administer operations. The CMS (Center for Medicare and Medicaid Services) contracts with these outside contractors to process claims and determine compliance with the rules. Consequently, these outside contractors are the ones who are responsible for payments from Medicare, interpreting the rules, and policing the industry within CMS professional practices.

An Easy Way to Perpetrate Fraud

Most health care professionals bill Medicare through an electronic claims submission system t. Although meant to be efficient, it also offers an easy way to perpetrate fraud.

If a Medicare provider has figured out a way to falsify claims and submit those claims through the electronic claims system or intentionally miscode to get higher reimbursements from Medicare, then these are examples of Medicare fraud that may lead to a whistleblower suit.

Is Medicare Too Big?

The Medicare system basically relies on trust with its providers. Because of the vastness of the program, it becomes ripe for fraud. With close to a billion claims filed annually, with many different carriers and a multitude of providers, policing the system and following up on claim validity is difficult. Consequently, investigators must focus on services where most fraud occurs, on system flags pointing to providers who overtly bill higher than others in their area, and on whistleblower claims under the False Claims Act.

Protection and Incentives Under the False Claims Act

The False Claims Act allows individuals to come forward when they have information about Medicare fraud and incentivizes this through a reward system for those people. Consequently, a successful whistleblower claim can recover substantial money for the government and also offer large rewards for a whistleblower if a recovery is made.

Getting Experienced Legal Advice

CMS rules can be extremely complicated. Consequently, someone who wants to file a whistleblower claim must get experienced and skilled guidance when pursuing a claim under the False Claims Act.

At the Khurana Law Firm, P.C., our skilled medicare whistleblower attorneys have dedicated our careers to representing those who come forward to play a critical role in detecting, reporting, and preventing Medicare fraud. We provide a confidential, no-obligation consultation to discuss your case and let you know if we think there is a viable case. You pay nothing unless there is a financial recovery. If you have knowledge of Medicare fraud, contact us to schedule an appointment.

The foregoing is for general use and is not legal advice. ATTORNEY ADVERTISING. PRIOR RESULTS DO NOT GUARANTEE A SIMILAR OUTCOME.