24/7 call for a free consultation 212-300-5196

AS SEEN ON

EXPERIENCEDTop Rated

YOU MAY HAVE SEEN TODD SPODEK ON THE NETFLIX SHOW
INVENTING ANNA

When you’re facing a federal issue, you need an attorney whose going to be available 24/7 to help you get the results and outcome you need. The value of working with the Spodek Law Group is that we treat each and every client like a member of our family.

Medicaid Fraud Lawyers

 

Medicaid Fraud Lawyers: An In-Depth Look

What Exactly is Medicaid Fraud?

Medicaid fraud refers to a range of illegal practices aimed at cheating the Medicaid system. Some common examples include:

  • Billing for services that were never provided
  • Billing for unnecessary medical tests or procedures
  • Upcoding to make services seem more expensive than they are
  • Accepting kickbacks for patient referrals

Basically, people abuse the Medicaid system to make money they don’t deserve. And we’re talking big money here – nearly $30 billion per year by some estimates!

Why Do People Commit Medicaid Fraud?

There are a few key motivations behind Medicaid fraud:

Greed

The most obvious reason is basic human greed. When healthcare providers realize they can score an extra buck (or million) by cheating the system, the temptation becomes too much for some.

Desperation

For other providers, rising costs and falling reimbursement rates have squeezed margins to the breaking point. So they tell themselves “just this once” in order to keep staff paid and doors open. Of course, that first taste often leads to more.

Opportunity

With over 70 million Americans on Medicaid, there are ample chances to take advantage of oversight gaps and understaffed oversight agencies. To unethical folks, billions in taxpayer funds can look like an unlocked vault begging to be raided.

Spotting Suspicious Activity

Because Medicaid fraud often flies under the radar, whistleblowers play a crucial role in catching scammers. So it’s important to know the red flags:

  • Sudden spikes in billing for certain services or procedures
  • Lots of patients receiving identical treatments
  • Services billed but never performed
  • Patients receiving care far beyond medical need
  • Doctors ordering excessive tests from owned labs

Of course, not all spikes or patterns mean fraud – but they warrant a closer look.

Reporting Medicaid Fraud

If you suspect Medicaid fraud, report it ASAP before the losses balloon. You can report to state and federal authorities:

  • Medicaid Fraud Control Unit (MFCU) – Operates in 49 states to investigate and prosecute fraud.
  • Office of Inspector General (OIG) – The OIG runs a hotline to report fraud in over 300 federal programs.

You can report anonymously or provide contact info for follow-ups. But to collect a financial reward, you’ll need to file a formal whistleblower lawsuit under the False Claims Act.

Whistleblower Rewards Under the False Claims Act

The False Claims Act lets whistleblowers sue fraudsters on behalf of government payers to recover stolen funds. For putting their necks on the line, whistleblowers can collect:

  • 15-30% of recovered funds if the government joins the lawsuit
  • 25-30% if the government doesn’t join but the whistleblower succeeds

So if you report $10 million in Medicaid fraud, you could potentially collect $2-3 million – not a bad reward!

Do You Need a Medicaid Fraud Lawyer?

You don’t “need” to hire a lawyer to report Medicaid fraud. But having an experienced whistleblower attorney on your side offers huge advantages:

Anonymity

Reporting fraud can put your job or safety at risk. But an attorney can keep your identity secret during the initial investigation.

Legal Expertise

Proving fraud requires navigating complex legal rules. An attorney knows how to gather evidence and build an ironclad case.

Larger Recoveries

An attorney can dig deeper to uncover more fraud…and that means a bigger reward check!

Stronger Protections

If you suffer retaliation for reporting fraud, experienced counsel can put a stop to it and get you compensation if you suffer adverse action.

So while not strictly required, having counsel vastly improves the whistleblowing process.

Choosing the Right Medicaid Fraud Lawyer

All attorneys are not equal when it comes to False Claims Act (FCA) litigation. Be sure to choose counsel with specific FCA experience, such as:

Deep Understanding of Healthcare Billing

The medical billing process is complicated, so your attorney must understand billing rules to recognize fraud.

Relationships With Government Attorneys

It helps immensely if your attorney has worked alongside the DOJ before and earned their respect.

Resources to Take on Big Targets

FCA cases demand heavy upfront resources for investigation and discovery. Look for an attorney with the bandwidth to dig deep.

Proven Record of Big Recoveries

At the end of the day, you want counsel who consistently delivers results for clients. Verify their past case outcomes!

The Risks of Blowing the Whistle

While whistleblowing offers financial upside, there are also risks to consider:

Retaliation

Your employer may try to punish or fire you for reporting fraud. Experienced counsel can put a stop to retaliation and get you compensation if you suffer adverse action.

No Government Intervention

The government declines to join about half of FCA cases. But that doesn’t mean you can’t proceed alone – and still earn a nice reward.

Loss After Trial

There’s no guarantee of winning at trial. But an experienced attorney will accurately gauge the strength of your case and chances of success.

The Rewards of Reporting Healthcare Fraud

While whistleblowing carries some risk, the potential benefits are well worth it:

Financial Reward – With billions lost to healthcare fraud each year, your reward for helping recover funds could be life-changing.

Protect Taxpayer Funds – Medicare, Medicaid and other programs face uncertain futures. By exposing fraud, you help stabilize vital healthcare resources.

Improve Patient Care – When providers commit fraud, patient health often suffers from unnecessary procedures or substandard treatment and testing protocols. Stopping fraud helps get patient care back on track.

Safeguard Jobs – If left unchecked, fraud could destabilize healthcare employers to the point of job losses or closing down altogether. Reporting fraud early can help preserve stability and jobs.

Make an Ethical Stand – Perhaps most importantly, blowing the whistle lets you take a stand for integrity over corruption. You’ll have the satisfaction of breaking the conspiracy of silence and shining light on the truth.

So if you suspect Medicaid fraud, contact experienced counsel to evaluate your case, guide you through the process, and help you secure the substantial financial reward you deserve as a whistleblower. It’s time we work together to stamp out fraud and protect this vital system for society’s most vulnerable.

Schedule Your Consultation Now