What is Medicare Fraud?

Medicare fraud occurs when a hospital, nursing home, doctor's office, hospice care facility, ambulance service, pharmacy, rehabilitation center, or any other type of healthcare provider overbills Medicare.


Who can report Medicare fraud?

Medicare fraud whistleblowers are almost always healthcare professionals. They are commonly employed as hospital administrators, nurses, hospice or nursing home workers, ambulance drivers, pharmacists, or as any other type of healthcare professionals.

Receive a financial reward for your information.

Healthcare professionals may be entitled to a significant financial reward for becoming Medicare whistleblowers. Learn about receiving a financial reward for your information here.


Medicare Fraud News
Four Plead Guilty to Medicare Fraud Scheme
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In a $14 million Medicare fraud scheme, four people plead guilty to charges against them. The Department of Justice, the Department of Health and Human Services and the FBI announced the guilty pleas. Curtis Mallory, a 38-year-old patient recruiter, Theodore Haile, a 33-year-old patient recruiter, Maira Suleman, a 31-year-old office manager at Patient Choice and John Thomas, a 33-year-old physical therapist for All American and Patient Choice were charged.

Government has Record Breaking Success Combating Health Care Fraud
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The latest report released by the Health Care Fraud and Abuse Control Program (HCFAC) reflects an unprecedented $4.1 billion dollars that was recovered from organizations and individuals who attempted to defraud the U.S. government by receiving improper health care reimbursements. The record amount represents the largest sum ever recovered in one year, and the recovery of the funds saves taxpayer dollars by returning money to the Medicare Trust Fund, the Treasury and other related programs.

The HCFAC report is released annually and is a joint effort of the Department of Health and Human Services (HHS) and the Justice Department. The report reflects the unqualified success of the Obama Administration's decision to make the elimination of fraud and waste a top priority. One of the major factors in this effort was the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) in 2009 to zero in on fraudsters abusing the Medicare and Medicaid programs.

Another change implemented in 2009 was the addition of more Medicare Fraud Strike Force Teams. Each team features personnel from the FBI, the Justice Department, and the HHS Office of Inspector General working together using advanced data analysis to identify unusual billing patterns which often indicate fraud. In 2011 alone, the Medicare Strike Force teams removed almost 200 Medicare fraud defendants from the health care system, with the majority facing an average prison sentence of almost 4 years. Including the strike force defendants, a record 743 federally prosecuted defendants were found guilty of health fraud.

An infusion of an additional $350 Million dollars to support the continued efforts of the HCFAC program combined with the implementation of additional fraud fighting provisions in the Affordable Care Act like improved cross agency data sharing, monitoring of private insurance abuse, and stronger screening standards will provide even more tools to combat fraud in health care reimbursements. The Affordable Care Act also opened the door for the establishment of definitive deadlines for the return of taxpayer money once an organization becomes aware that they have received Medicare or Medicaid overpayments, greatly improving the ability of the government to recover overpayments in a timely manner.

The Obama Administration also initiated an increased effort to educate Medicare recipients on ways to protect themselves from fraud, and educate Medicare providers via compliance training and regional summits on the best practices for avoiding fraud and complying with federal and state law.

Report Medicare fraud here.

Help stop government waste and abuse, and get rewarded for your efforts. Our attorneys have significant experience representing healthcare industry whisteblowers. Complete the secure form on this page or call 1-800-581-1790 for a free no obligation consultation with a lawyer.

Detroit-area resident Pleads Guilty to Medicare Fraud
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Tausif Rahman, a Detroit-area resident, has pleaded guilty to participating in a money laundering scheme as well as Medicare Fraud. The fraud and money laundering scheme is estimated to have cost the tax-payers $14 million. 

Miami Home Health Care Company Guilty in a $22 million home health Medicare fraud scheme
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According to a recent DOJ press release, Marietha Morales and Eduardo Saborit-Dominguez; the owner and employee of a Miami healthcare agency,  have pleaded guilty to charges involving a $22 million home health Medicare fraud scheme. 

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