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Feb 9, 2015 by |

Medicare Fraud and Those Who Report It

Hundreds of thousands of people rely on Medicare and Medicaid programs for their health care needs. As the country continues to adapt to new health care laws and insurance coverage requirements and options, these programs are struggling with fraudulent claims and activities from outside clients who utilize their services, as well as workers on the inside. Combating Medicare and Medicaid fraud is tricky, because people who see fraud in action or witness suspicious or compromising activity going on have to speak up and report their findings.

Whistleblower Protections

State and federal laws provide protection to anyone who acts as a whistleblower to report fraud or unlawful behavior going on in a company or institution. However, reporting fraud can be hard on the whistleblower because although there are laws prohibiting retaliation, the fear of losing a job or being isolated from other coworkers or treated poorly within the company as a result can be overwhelming.

For this reason, many fraudulent employers and employees go undetected. In cases involving Medicare and other federally-funded programs, fraud schemes cost taxpayers a great deal of money and could put those who utilize the program’s services at risk of lower coverage, lack of funding or being dropped altogether. Doctors and medical workers who treat Medicare patients might overbill the program for services that were not performed or medications that were not prescribed in order to receive a larger compensation from the program. Additionally, falsified claims—both from insured patients and their doctors—can cost the program significant amounts of money.

Many potential whistleblowers feel that it may not be worth it to report fraudulent activity when it could jeopardize their jobs or financial security because it is hard to know exactly what will happen. The manager or human resources department who receives the report of fraud may not handle it or may, in turn, report the employee to their manager or a higher-level co-worker, especially if they are involved in the fraud as well. If a person reports Medicare fraud to the regulatory agency outside their individual company, his or her identity will be protected should the agency choose to investigate.

Take Action

A skilled whistleblower attorney can protect you if you uncover fraudulent or illegal activity in your workplace, or if you discover that the Medicare program is being exploited. Legally, your employer cannot take action against you and if the company attempts to fire you, harass you or bribe you into keeping your mouth shut, you have even more grounds to take action against them.

At the Evans Law Firm, Inc., our whistleblower attorneys represent clients in Santa Clara County and the surrounding areas. We help whistleblowers who have reported Medicare and Medicaid fraud happening in their places of employment to retain their jobs and keep them from suffering illegal blowback as a result. To discuss your case with a one of our lawyers, contact the Evans Law Firm, Inc. at 415.441.8669 or online at

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