A whistleblower has assisted the government in recovering $6,375,000 after speaking out over alleged Medicare fraud.  According to the Department of Justice press release, a company participating in the Medicare Advantage Plan—also known as Medicare Part C—submitted diagnoses that were not supported by patients’ medical records, inducing a higher rate of reimbursement from the government.

Under the Medicaid Advantage program, certain beneficiaries are able to opt in to plans operated by private insurance, known as Medicare Advantage Organizations (MAO’s).  The government reimburses these MAO’s at a fixed rate based on beneficiaries’ health status.  These rates are determined by periodic reports by MAO’s on beneficiaries’ diagnoses and other health information.

This lawsuit was brought under the False Claims Act (FCA), which allows whistleblowers who uncover fraud against the government to file a lawsuit and attempt to recover the lost assets.  Under the FCA, whistleblowers are also entitled to receive a share of any recovery.  Here, the whistleblower will receive $1,500,000.

If you have uncovered fraud against the government, contact the whistleblower lawyers at Miller Law Group today for a free and confidential consultation.  You can also set up your consultation by calling us at (919) 348-4361.  To learn more about whistleblower law, click here.

The settlement discussed above is based on allegations only.  No determination of liability have been made.

Additional Resources:

Recent Developments in Whistleblower Protection

North Carolina False Claims Act

Medical Billing and Coding Fraud