Medicaid Medicare Fraud

Medicare and Medicaid are programs that offer publicly allotted money from taxpayers to provide essential healthcare benefits to millions of American citizens. The money from Medicaid and Medicare helps fund medicals bills for the disabled, the poor, and some of the most vulnerable people in America. However, many organizations unfortunately take advantage of the millions of dollars in public finding by committing fraud. Even worse, many employers that receive funding from Medicaid and Medicare retaliate against employees who “blow-the-whistle” after discovering fraudulent and illegal behavior. Luckily, there are numerous state and federal laws that protect employees who report Medicaid Medicare fraud.

There are many ways that Medicare and Medicaid fraud can occur. Often times than not, there are common occurrences. Some of the most frequent forms of Medicare and Medicaid include:

• False Billing: fraudulent notifying Medicare and Medicaid that services were performed, but in reality, they were not.
• Over-Billing: this occurs when the organization illegally bills higher rates than normal.
• Kickback Schemes: A kickback is an illegal payment in return for patient referrals or other services
• Billing by Persons Who Do Not Have the Proper Credentials: for example, nurses cannot prescribe medications, but often times, organizations require these individuals to dole out medications without the proper credentials.
• Fraudulent Cost Reports
• Unnecessary Billing: including, hiking up the amount charged for services
• Fraudulently Charging for Brand Name Drugs: including providing generic drugs for the price of brand name drugs.
• Altering Drugs: this includes diluting the potency of drugs to save money
• Falsifying Ambulance Records

This list is not complete and there are many other ways employers often times fraudulently induce Medicare and Medicaid to provide funding when they should not.

If you have reported any of the above practices to anyone within the company or to any governmental agency, you are protected from retaliation under numerous Federal and State Laws. Some of these laws include:

• False Claims Act: a Federal law that allows employees to sue for damages on behalf of the government. These whistleblowers can potentially get compensated up to 15-25% of the total amount recovered. In fact, the federal government has recovered billions of dollars since the inception of the False Claims Act.
• Occupational Safety and Health Administration (OSHA): whistleblowers who report violations of OSHA statutes are granted absolute protection under Labor Code 6311.
• Labor Code Section 1102.5: whistleblowers who, in good-faith, report any violation of law to either the government agency or anyone within the company are granted protection under Labor Code 1102.5.
• Labor Code Section 98.6: This labor code carries a $10,000 statutory penalty for employer who retaliate against employees who complain about labor code violations
• Labor Code Section 6310: this law protects employees who report safety hazards.

Do not make the mistake by trying to go after your employer alone. The Medicaid Medicare fraud attorney at Miracle Mile Law Group will assist you in filing a claim against your employer for illegal behavior.