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Whistleblower Claims

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Government recovers $900 million in the largest ever Medicare Fraud takedown

posted on: July 12, 2016

author: Andrew Brashier

According to the Department of Justice (DOJ), more than 300 people have been charged with Medicare fraud this year, recovering more than $900 million. This is the largest takedown against defendants attempting to defraud the government through Medicare.

This record beats the record set last year when 243 defendants were charged with a loss amount of $712 million.

When a person or business defrauds the government through Medicare, that person or business is stealing money out of the taxpayer’s pocket. Moreover, Medicare fraud results in money intended to be spent on health care being spent on unnecessary procedures, procedures that never took place, or other frivolous expenditures. One driving factor behind the government’s war on fraud is that the trust fund, which supports Medicare, is now projected to be depleted by 2028.

U.S. Attorney General Loretta Lynch stated, “As this takedown should make clear, health care fraud is not an abstract violation or benign offense – it is a serious crime. The wrongdoers that we pursue in these operations seek to use public funds for private enrichments. They target real people – many of them in need of significant medical care.

They promise effective cures and therapies, but they provide none. Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends.”

According to the DOJ about 50 percent of the cases involved in the takedown dealt with home health fraud, whereas about 25 percent involved pharmacy fraud. Some of these cases involved doctors who billed more than $38 million for home health serves, which were ether not needed or not provided.

Other cases involved physical therapists billing for care not needed or not provided. Overall, arrests took place in 36 federal districts across the country, from southern California to southern Florida and Texas to New York. These arrests were comprised of 29 doctors, eight pharmacists, 11 nurses or physician assistants, nine medical counselors, and others.

The government is waging a war on fraud, and the False Claims Act (FCA) is its biggest weapon. The FCA includes a whistleblower provision to incentivize taxpayers to report fraud to the government. The incentives allow the whistleblower to recover 15 to 30 percent of the  funds recovered. The whistleblower provision has helped the government to (1) detect more fraud, (2) ensure taxpayer money intended for health care is properly spent on health care, and (3) deter others from committing the same fraud.

Are you aware of fraud being committed against the federal government, or a state government? If so, the FCA can protect and reward you for doing the right thing by reporting the fraud. If you have any questions about whether you qualify as a whistleblower, please contact attorney Henry C. Dailey for a free and confidential evaluation of your claim. There is a contact form on this website, or you may email or call us at (205) 995-2412.

Sources: Reuters, Law360, CBS News


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