The federal government’s healthcare programs, known as Medicare and Medicaid, provide healthcare services to the country’s most vulnerable people. Both of these programs rely on the truthful acts of both patients and providers to offer this care at a reasonable cost and efficiency level.
Unfortunately, fraud in the healthcare world is common. Individuals may misstate their incomes to qualify for programs. At the same time, providers may improperly bill Medicare or Medicaid for services that they did not provide. The federal government often relies on information from whistleblowers to learn about and investigate these crimes.
A Charleston Medicare and Medicaid fraud lawyer could help individuals who have information concerning abuses of Medicare or Medicaid. This help may include performing an in-depth investigation into the incident, forming formal complaints, and demanding appropriate rewards through writs of Qui Tam.
The federal government’s Medicare and Medicaid programs provide direct funding for significant portions of an individual’s healthcare costs. If people are members of this program, they must find a provider who accepts this form of payment. At the same time, providers must be sure to properly bill the treatment that they provide to patients.
Failures on either side of this process may count as healthcare fraud. For example, individuals only qualify for enrollment in Medicare if they are 65 years of age or older, or a United States. citizen or a legal permanent resident living in the U.S. for at least five years. Lying about these qualifying factors on an application for Medicare is an example of healthcare fraud.
Providers may also commit fraud by accepting patients whom they know are not proper members of these healthcare plans or by improperly billing for treatment that they did not provide. A Charleston Medicare and Medicaid fraud attorney could help to take the lead in investigating apparent violations of Medicare or Medicaid law.
For the most part, it is never a requirement to blow the whistle when a person observes healthcare fraud. However, the motivation to do so can be strong.
Healthcare fraud is usually a violation of the False Claims Act. Under 31 United States Code § 3729, it is illegal to knowingly submit information demanding payment to the federal government that a party knows is false. Improper claims forms or applications for enrollment certainly fall under this category. Blowing the whistle on this behavior can help the government to recover funds that lower the overall tax burden on citizens.
In addition, serving as a whistleblower can come with financial advantages for an individual. 31 United States Code § 3730(c)(5) says that a successful investigation that results from a whistleblower complaint entitles a whistleblower to a reward based upon the funds recovered in the case. This reward will be from between 15 to 25 percent of the cash recovered by the government. A Charleston Medicare and Medicaid fraud lawyer could assist parties in demanding these rewards.
The government-funded healthcare programs comprise a significant portion of the country’s annual spending. Despite this fact, the government lacks the resources to properly oversee the distribution of funds and the overall authenticity of these programs. Due to this, they rely on whistleblowers to report allegations of fraud that may lead to in-depth investigations.
If you believe that you have observed incidents involving healthcare fraud, a Charleston Medicare and Medicaid fraud lawyer may be able to help. An attorney can take the lead to further investigate the incident, form comprehensive complaints, and demand rewards by filing writs of Qui Tam. Reach out to an attorney in Charleston today to learn more.