Medicare and Medicaid are federal programs that assist millions of Americans in getting the medical care they need. Providers who accept Medicare and Medicaid payments have very strict guidelines for what’s allowable.
Unfortunately, not all providers handle things in an appropriate manner when it’s time to bill for services. They may try to take advantage of the programs by using fraudulent billing practices. They often do this by billing for services never provided, inflating costs or submitting false claims.
Whistleblowers can help to protect these programs
Whistleblowers play a critical role in bringing these billing schemes to light, helping recover billions of dollars every year for taxpayers. Blowing the whistle on fraud can feel risky, especially if it involves a person’s employer. That’s why the law offers important protections to help shield whistleblowers from retaliation. An employer can’t legally fire, demote, harass or discriminate against someone because they reported fraud.
If retaliation does happen, whistleblowers can file a lawsuit seeking remedies like:
- Reinstatement to their job if they were fired
- Double back pay for lost wages
- Compensation for any special damages, like emotional distress or legal costs
Many whistleblower claims remain “under seal” while the government investigates. This means their identity might stay confidential for a period of time while officials gather evidence. However, in some cases, the whistleblower’s name could eventually become public if the case goes forward in court.
Anyone who’s reporting Medicare or Medicaid fraud should keep thorough records that show the complaint is valid. Emails, billing records and notes about suspicious activities may be beneficial. Learning about whistleblower protections and how to invoke them may help them as they move forward with this process.