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Whistleblower Medicaid

Medicaid whistleblowers have uncovered billions of dollars' worth of fraud related to this government health insurance program. Funded by both the states and the federal government, Medicaid provides healthcare coverage for eligible individuals and families with low income and limited resources. Medicaid fraud has been a constant problem ever since the program started in 1965.

Medicaid Fraud Control Units

Every state has a Medicaid fraud control unit, often as part of its Attorney General's office. Medicaid fraud reports from whistleblowers - often employees at the offices of healthcare facilities, physicians, pharmacies, etc. - are processed in a Medicaid fraud unit to examine the possibility of criminal charges (state and federal).

Examples of Medicaid Fraud

For example, the Medicaid Fraud Control Unit (MFCU) of the Maryland Attorney General's Office announced in spring 2008 that two elderly pharmacists defrauded the Medicaid program of over $400,000 over a period of less than two years. Each man netted about $200,000 in their small-town pharmacy scheme that billed the Medicaid program twice for unused medications. However, this example of Medicaid fraud in Maryland is "peanuts" compared to a recent Florida revelation.

The Center for Medicare & Medicaid Services reported in January 2009 that over $56 million in Medicaid fraud and abuse occurred in the last fiscal year. Indeed, state officials estimate that Medicaid fraud, waste and abuse in Florida alone (the fourth largest Medicaid program in the U.S.) could amount to as much as $2 billion a year.

Medicaid Fraud Reporting

Many methods and schemes have been used to defraud Medicaid programs. Just a few examples are:

  • healthcare providers billing for medical services (e.g., tests, procedures) that were never performed
  • subjecting patients to unnecessary procedures
  • billing the program for drugs, medical devices and products that are never used
  • billing for services performed that were not medically necessary
  • double-billing for services or products
  • paying a kickback in exchange for a referral for medical services or products
  • billing for more hours than there are in a single day

How to Report Medicaid Fraud

If you suspect Medicaid fraud, you can be a whistleblower. You may qualify to receive a percentage of money recovered by your state when they have prosecuted Medicaid fraud. Each state's guidelines and policies are unique, so it's also a good idea to contact a Medicaid fraud attorney in your state. To schedule a private consultation with an experienced whistleblower attorney, contact us today.

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