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.


Florida radiology clinic settles Medicare fraud allegations
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The US Department of Justice (DOJ) issued a press release on June 8, 2011 saying a Florida radiology clinic and its former owners would pay $3 million to settle Medicare False Claims Act (FCA) allegations.

The clinic, Midtown Imaging LLC and its former owners, Midtown Imaging P.A. and PBC Medical Imaging, allegedly submitted false claims to Medicare from 2000 to 2008.

Specifically, the clinic entered into professional services and leasing agreements with referring doctors and physician groups. These actions violated both the Anti-Kickback Statute and the Stark Law.

The Anti-Kickback Statute was enacted to put an end to clinics and hospitals offering inducements to physicians for patient referrals covered by federally-funded programs such as Medicare and Medicaid.

The Stark Law is slightly different. Its aim is to prevent profiteering from patient referrals made by doctors with whom the admitting entity has an improper financial alliance.

Both laws guard against a doctor’s medical judgment being impaired by improper financial incentives, rather than the patient’s best interests.

The Medicare fraud came to light as the result of citizen whistleblowers. Such people are allowed to file suit on behalf of the federal government when they spot fraudulent activity in government programs.

In this case, the whistle was blown by two former Midtown Imaging radiologists. Their suit alleged Midtown Imaging was involved in prohibited financial relationships with certain physicians and physician groups.

The two radiologists, Dr. Teresa M. Cortinas and Dr. Walter E. Wojcicki, will share $600,000 for their efforts in uncovering and prosecuting the fraud.

The government takes healthcare fraud like this very seriously and goes to extraordinary lengths to find and prosecute it.

A new program, a joint effort between the Health and Human Services Department and the Department of Justice, the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative was announced in May, 2009.

HEAT’s charter is to prevent and reduce Medicare fraud and Medicaid fraud. The organization leans heavily on the FCA. The Act has helped DOJ recover more than $5.7 billion since 2009 in health care fraud cases.

Report Medicare fraud here.

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