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.


Health Care Fraud and Abuse Control Program Annual Report: Medicare fraud in 2009
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On May 13, 2010, Attorney General Eric Holder and U.S. Department of Health and Human Services Secretary Kathleen Sebelius reported the results of the 2009 Health Care Fraud and Abuse Control Program Annual Report (HCFAC).
The report summarized fiscal year 2009’s health care fraud prevention and enforcement accomplishments.

The two departments have worked closely together to address health care fraud, working the gamut from prevention to identification and prosecution of the worst offenders.

Some highlights of the report included:

  • The Medicare Trust Fund received almost $2.5 billion in fiscal year 2009, an increase of more than half a billion dollars over the prior year’s total.
  • Judgments and settlements totaled $1.6 billion
  • Prosecutions and investigations climbed. More than 1,000 new criminal health care fraud investigations were opened and more than 1,600 health care fraud criminal investigations are pending
  • Indictments grew to an “all-time high”: more than 800 health care fraud defendants in nearly 500 cases filed, with close to 600 convictions The federal government has made the health care fraud fight a cabinet-level priority. The partnership between DOJ and HHS marks a new level of commitment on a federal level.

One notable step in the fight against Medicare fraud is the establishment of the DOJ-HHS Health Care Fraud Prevention & Enforcement Action Team, or HEAT.

HEAT set up Medicare Fraud Strike Forces in 5 cities that have experienced high levels of fraud.

The forces have made significant progress already:

  • Force prosecutors have gone after $500 million in court-ordered restitution to the Medicare program in almost 300 health care fraud cases, counting more than 560 defendants.
  • 300 of those defendants have already registered guilty pleas. And 250 defendants have gone to prison – receiving sentences ranging from two months to 30 years.
  • Civil enforcement gains have been equally impressive: health care fraud recoveries under the False Claims Act last year exceeded $2.2 billion dollars.

The departments were happy with their progress to date but pledged continued and increased efforts. They said tough new rules and penalties contained in the Affordable Care Act will give them the help they need to stop Medicare fraud in its tracks.

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.