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Consequences of Medicare Fraud

Medicare fraud is a serious problem within the healthcare system. Medicare fraud has severe consequences for patient health and for the long-term viability of the Medicare program. Fighting fraud is of vital importance, but all-too-often investigations are costly, time-consuming and difficult. 

The government needs help from whistleblowers to effectively fight Medicare fraud and it rewards those who step forward to help by allowing whistleblowers who bring qui tam lawsuits to recover a portion of the funds that the government fraudulently paid out but was able to recoup.

If you believe you have evidence of Medicare fraud, you should talk with an attorney to find out how to take action and do your part to protect the Medicare program that vulnerable seniors rely on. You could be financially rewarded for doing the right thing.

ABC News reported on the serious problem of Medicare fraud. According to the ABC News Report, the Government Accountability Office conducted a review of improper Medicare payments and found extensive fraudulent claims within the Medicare program.

More than $60 billion of taxpayer money was lost due to Medicare fraud in just one single year, according to the GAO's investigation into fraudulent claims. This is approximately 10 percent of the total budget for the Medicare program.  The money was paid out due to improper claims, or was lost because of abuse and fraud. In some cases, money was paid to "providers" that weren't actually even real healthcare providers. For example, more than 24,000 fake addresses were found on Medicare's list of providers.

This problem of fraudulent addresses is a big issue that has been a problem for decades. Back in 1998, for example, an investigation revealed that $6 million in payments had been made to a business that gave an address which was actually inside of the Miami airport.  The recent report shows "no improvements," from this problem even though investigators suggest that fixing the issue of fake addresses shouldn't be that hard.

While fixing the fake address problem could be done with a little bit of effort at checking provider locations, other types of Medicare fraud are harder to root out.... like doctors billing for services that they do not provide or doctors billing for more expensive services than patients need.  It is these kinds of fraud that are often difficult for outside investigators to detect and that whistleblowers can be especially effective in bringing to light.

Whistleblowers can and should speak up whenever possible to help protect the integrity of the Medicare program so these big losses can be stopped. Sen. Tom Carper, who had requested the GAO review of the Medicare program, told ABC: ""This is money that costs the Medicare trust fund real money." It is money that is being taken from every working person who pays Medicare taxes in order to support the Medicare trust fund.