Whistleblowers are Critical in Preventing, Limiting Medicare Fraud

During a recent interview with the AARP, U.S. Attorney General Jeff Sessions said Medicare fraud must be taken as seriously as the war on drugs in this country. That’s saying something, considering the hardline stance Sessions has taken on the enforcement of drug laws. However, it’s not difficult to see why he’s so passionate about it, as approximately 10 percent of Medicare funds are lost every year to fraud and general waste. That adds up to about $16.2 billion annually.

Whistleblowers play a crucial role in the limitation of Medicare fraud. Their close proximity to the wrongdoing makes them uniquely situated to discover fraudulent and predatory practices, and to report those practices when possible. Without the assistance of internal whistleblowers, the governing agencies responsible for cracking down on Medicare fraud would rarely get the evidence they need to take enforcement action.

Using the False Claims Act

The False Claims Act (FCA) is one of the most commonly used laws by whistleblowers who uncover instances of fraud in their workplace. Under the FCA, whistleblowers can file lawsuits on behalf of the federal government. If their case leads to successful enforcement actions, the whistleblowers may collect between 15 and 30 percent of funds collected in a verdict or settlement.

The growing number of FCA cases over the past several years has played a significant role in the more widespread discovery of Medicare fraud. Officials strongly believe that if the awards for whistleblowers were increased, the FCA would become even more powerful and more whistleblowers would come forward. About 92 percent of all money the government collected under the FCA last year came from cases initially started by whistleblowers.

The U.S. Department of Justice has floated around ideas that would limit the number of FCA cases, even though they are crucial for limiting fraud and abuse.

For further guidance on how you can file a claim under the False Claims Act, meet with an experienced Dallas attorney at Kardell Law Group.