Medicare Fraud Whistleblower – Paying Patient Co-pays

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Whistleblowers who uncover schemes by medical providers to pay their patients’ Medicare co-pays could receive a monetary award and protections under state and federal law.

The Anti-Kickback Statute (AKS) prohibits medical providers and pharmaceutical companies from offering or paying any remuneration to induce Medicare patients to purchase prescriptions or receive medical services. When a Medicare beneficiary receives a prescription covered by Medicare Part D, the beneficiary must typically make a partial payment.  These co-pays are intended to encourage private companies to keep costs low.  When a company fraudulently pays these co-pays, they can charge higher prices to the government without running the risk of turning away potential clients due to high co-pays.

Whistleblowers who uncover fraud that violates the AKS may bring a civil action on behalf of the government under the False Claims Act (FCA).  The FCA allows the whistleblower to receive a share of any monetary recovery.  In kickback cases, the recovery can be extremely high.  This is because the fraud amount is deemed to be the sum total of payments made by the government to the fraudster.  Moreover, under the FCA, actual damages are trebled, meaning the whistleblower and the government can seek three times the actual fraud amount, in addition to civil penalties.

The FCA also affords whistleblowers powerful protections against retaliation they may face in the workplace for reporting the fraud.  This retaliation provision is critical, as many whistleblowers report the conduct of their employers.

Many states, including North Carolina also have false claims acts.  This allows whistleblowers to similarly fight fraud on state programs like Medicaid.

If you have uncovered fraud against the government, contact the whistleblower attorneys at Miller Law Group today for a free and confidential consultation.  You can also set up a consultation by calling us at (919) 348-4361.

Additional Resources:

Whistleblower helps recover $72.3 million in kickback case

Filing a Whistleblower Lawsuits in Secret – The Seal Period

STARK: When can physicians refer patients to their group practice?