Google “How to Report Medicare Fraud” and at the top of the listings will be Medicare.gov’s website. According to the government, the best ways to report Medicare fraud are:
- Call us at 1-800-MEDICARE (1-800-633-4227)
- Report it online to the Office of the Inspector General.
- Call the Office of the Inspector General at 1‑800‑HHS‑TIPS (1‑800‑447‑8477).
Not only aren’t those methods particularly effective, NONE of them will pay you a whistleblower reward.
The two primary motivations for whistleblowers are 1) a genuine desire to stop greed and fraud and 2) claiming a cash reward. Calling the Medicare fraud hotline (or using their online form) doesn’t do either.
Why Call the Medicare Fraud Hotline if Not Effective?
We love the auditors and special agents at the U.S. Department of Health and Human Services. The problem is that there aren’t enough of them. The hotline gets tens of thousands of calls. And most of them aren’t thoroughly investigated.
Compare the Medicare Fraud Hotline to the federal False Claims Act, the law that pays whistleblower rewards. In 2017, just 704 complaints were filed under the Act. All prepared by lawyers.
Because they are prepared by lawyers and filed in federal court, these cases generally contain the “who, what, when, where and how” needed to properly investigate a case. They also go to the top of the list for auditors and investigators. By law, these claims have to be investigated.
If you really want to stop fraud, consider reporting Medicare the right way – by filing a False Claims Act complaint. (Don’t worry about costs and legal fees, most whistleblower lawyers advance all costs and only collect a fee if they are successful in collecting you a reward.)
In fact, the only reasons to use the hotline are if you don’t have much information or want to be totally anonymous. Unfortunately, anonymously filed cases go to the bottom of an otherwise huge pile.
False Claims Act Medicare Fraud Claims Pay Cash Rewards
The primary reason people report Medicare fraud isn’t the reward. Most whistleblowers try to fix problems internally. Only when they are ignored or suffer retaliation do most seek out a whistleblower lawyer.
Even though the primary motivation of most whistleblowers isn’t the money, cash rewards are still necessary. When whistleblowers come to us, they frequently do so because they were fired, demoted or ostracized for trying to get their company to follow the law. Congress understood that strong anti-retaliation provisions and cash rewards were necessary to get many people to report the fraud to authorities.
Under the False Claims Act, whistleblowers can receive between 15% and 30% of whatever the wrongdoers pay the government. And the money comes from the wrongdoers, not taxpayers.
Some of the largest Medicare fraud recoveries to date were begun by whistleblowers. For example, in 2012 GlaxoSmithKline paid a total of $3 billion to settle charges that the company engaged in illegal marketing practices over several of their drugs. Off label marketing is treated as Medicare fraud if the federal government reimburses patients for those drugs. (Almost all prescription drugs are covered by Medicare.)
Four whistleblowers shared a total of $250 million reward!
HCA, one of the largest for-profit hospital companies, twice paid approximately $150 million to whistleblowers. One case involved kickbacks to physicians ($641 million paid to the government). Another case involved billing fraud and billing for unnecessary lab tests ($745 million plus $95 in criminal fines).
Even the recent cases involving the opioid epidemic have often been brought under the False Claims Act.
Using the Medicare Fraud Hotline Doesn’t Protect You from Retaliation
Congress knew that some employers would try to punish whistleblowers. They built strong anti-retaliation and whistleblower protection measures into the False Claims Act. Those protections, however, aren’t available if you simply file a claim on the hotline.
To receive the full protections of the statute, you must file a complaint in federal court.
Those protections include attorneys’ fees, damages, and double lost wages.
When you call the SEC to make a whistleblower tip, you receive the anti-retaliation protections of the SEC and you have the ability to collect a reward simply by filling out their online form. Unfortunately, that isn’t the case with Medicare fraud cases under the False Claims Act. [Note to potential SEC whistleblowers, we still urge hiring an attorney. The SEC issues rewards in less than 1% of the cases reported online.]
About the only reason to report Medicare fraud on the Medicare fraud hotline is the anonymity it affords. (Remember, however, that anonymous complaints typically go to the bottom of the pile and are rarely acted upon.)
Once upon a time, judges allowed False Claims Act whistleblowers to file as a Jane Doe or through an entity such as a single purpose LLC. Those days are nearly over, however.
The good news is that even though anonymous filings are now discredited, most False Claims Act complaints remain under seal for at least a year meaning they remain secret. That gives whistleblowers who are still employed by the wrongdoer plenty of time to find a new job if uncomfortable about remaining at the same company.
Whistleblower are needed now more than ever. Medicare fraud is growing more sophisticated. For example, gone are the days when kickbacks are paid in cash. Today healthcare providers use sophisticated arrangements to hide billing fraud, kickbacks and off label use of drugs.
To learn more about healthcare fraud and how to qualify for a whistleblower reward, visit our Medicare fraud whistleblower page or our whistleblower FAQ pages. Ready to see if you qualify for a reward? Contact us online, by email at *protected email* or by phone at 414-704-6731 (direct). All inquiries kept completely confidential. No fees charged unless we recover money for you.
Whatever you do, don’t use the Medicare fraud hotline or online HHS tip form if you are interested in earning a reward or being protected from retaliation.
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