The Fraud Crisis in Medicare and Medicaid

Every day, the government announces another multi-million dollar Medicare or Medicaid fraud settlement.  Today there was not one announcement, but three.

First, a Johnson & Johnson subsidiary agreed to pay $18 million to settle claims that it caused physicians to submit false claims to Medicare by marketing a medical device for use as a drug-delivery device for prescription corticosteroids, when that use was not approved by the FDA.

Second, a hospital in South Carolina agreed to pay $17 million to settle claims that it submitted false claims to Medicare and Medicaid, and that it provided financial incentives to doctors for patient referrals.

Third, a diagnostic imaging company agreed to pay $3.5 million to settle claims that it billed Medicare and Medicaid for services that were provided without adequate supervision.

Three settlements.  Almost $40 million.  All announced in just one, typical day in the healthcare fraud arena.

Why is there so much fraud in Medicare and Medicaid?  Because the government cannot find fraud without help from insiders.

Medicare and Medicaid receive more than 1 million claims for reimbursement every day.  There is no way for the government to know whether each of those one million claims involved services that were medically necessary, or were properly supervised, or were billed using the proper billing code and not a code for a more expensive procedure.

That is why the government relies on – and rewards – whistleblowers who come forward with evidence of fraud.  In the South Carolina hospital case, for example, the government began its investigation only after a physician who worked for the hospital came forward with evidence of improper billing and financial incentives.

Now that doctor will receive a whistleblower reward of between 15% and 25% of the amount recovered – which will be somewhere in the range of $2.5 million and $4.25 million.

If you have evidence that a healthcare provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights.  You may be entitled to legal protections and a substantial reward.

To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728.  Do not delay.  There are strict time limits and procedural requirements to qualify as a whistleblower.