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.


U.S. Files Medicare Fraud Claim Against Hospice Provider With Help from Medicare Fraud Whistleblower
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The Justice Department has filed a complaint in an Alabama District court against Golden Gate Ancillary LLC, a company providing end of life care at an estimated 65 locations in Alabama, Wisconsin, Georgia, and 16 other states. The complaint alleges that Golden Gate Ancillary was in violation of the law when it deliberately defrauded the government by receiving millions of dollars in taxpayer funds to provide hospice care to Medicare patients who they knew were not entitled to the funds because they were not terminally ill.
Hospice care is designed to bring short term relief of pain and to patients diagnosed with terminal illnesses who are expected to live for six or fewer months. Although hospice patients are eligible to receive a wide range of medical and psychological treatments as part of their end of life care, once a patient is designated to receive hospice services, they no longer qualify for Medicare benefits for treatments whose sole purpose would be to cure their underlying illness.

The alleged fraud originally came to light as a result of a whistleblower lawsuit filed by two former employees of Golden Gate Ancillary, Dawn Richardson and Marsha Brown who claim to have witnessed numerous incidents of misconduct in relation to the improper disbursement of Medicare hospice funds for non-terminal patients at their former employer. If the case against Golden Gate Ancillary is successful, the federal government will be able to recover triple the amount of actual damages incurred in addition to a maximum penalty of $11,000 per fraud claim. 

The investigation that ultimately led to the court complaint was a joint effort of the Civil Division of the Justice Department, the Department of Health and Human Services’ Office of Inspector General, and the U.S. Attorney’s Offices in the Northern District of Alabama and the Eastern District of Wisconsin.

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