By skyforbes 
Do You Have Insider Knowledge of Medicare or Medicaid Fraud Being Committed?
Did you know that whistleblowers can receive significant financial rewards for reporting abuse of Medicare and Medicaid? These courageous individuals can expose systematic fraud, helping protect taxpayer money and ensuring the integrity of critical healthcare programs. By coming forward with documented evidence of improper billing, unnecessary medical procedures, or kickback schemes, whistleblowers can trigger investigations that potentially recover millions of dollars for the government.
Medicare and Medicaid fraud are among the most common types of fraud on the government, costing taxpayers billions of dollars each year. Since January of 2009, the U.S. Justice Department has recovered more than $24 billion related to False Claims Act (FCA) cases surrounding fraud against federal health care programs.
Medicare and Medicaid fraud occurs, for example, when a healthcare provider bills the government for supplies or services that were not actually provided. Medicare fraud is rampant and costs taxpayers billions of dollars a year, often affecting vulnerable populations who rely on Medicare to receive critical treatment.
Whistleblowers are essentially healthcare heroes, using their insider knowledge to prevent fraud, protect patient care, and maintain the financial sustainability of Medicare and Medicaid. Their actions not only recover misappropriated funds but also deter future fraudulent activities in the healthcare system.
What Kinds of Medicare and Medicaid Fraud Are Common?
Medicare and Medicaid fraud can take a number of forms, including the following:
• Upcoding: seeking payment for higher and more expensive medical services than those that were actually performed
• Overbilling: charging inflated prices for medication or for medication that were not actually provided
• Kickbacks: making improper payments or offers of financial incentive for the referral of Medicare of Medicaid patients
• Unnecessary Procedures: ordering unnecessary medical procedures to be billed to Medicare or Medicaid in order to boost profits
Largest Whistleblower Cases of Medicare or Medicaid Fraud
Several high-profile whistleblower cases have exposed significant Medicare and Medicaid fraud in recent years:
Humana Medicare Fraud: Humana agreed to pay $90 million to settle allegations of fraudulent bids for Medicare Part D contracts from 2011 to 2017, overcharging the government for medication.
Walgreens Medicare & Medicaid Overbilling Fraud: Walgreens Boots Alliance Inc. paid $269.2 million in 2019 to settle two whistleblower cases for overbilling Medicare, Medicaid, and other health programs for insulin pens and prescription drugs.
UnitedHealth Group Medicare Advantage Fraud: The U.S. Justice Department sued UnitedHealth Group twice for wrongfully obtaining over $1 billion from Medicare Advantage.
Bayer Medicaid Fraud: Bayer Corporation paid a $251 million civil settlement and a $5.6 million criminal fine for a fraudulent “private labeling” scheme to avoid paying rebates to Medicaid.
Cigna Diagnosis Code Fraud: Cigna agreed to pay over $172 million to settle allegations of diagnosis code fraud in Medicare Advantage.
Dr. Farid Fata Chemotherapy Fraud: Dr. Fata was convicted of administering chemotherapy to over 500 patients who didn’t have cancer, resulting in $34 million of fraudulent Medicare claims.