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.


DOJ: $4.1 Billion in Medicare Fraud Recovered in 2011
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A report released February 14, 2012 shows a record-breaking $4.1 billion has been recovered as a result of health care fraud prevention and enforcement efforts during the 2011 Fiscal Year. The findings, listed in the annual Health Care Fraud and Abuse Control Program report, credit the Obama administration with making it a top priority to eliminate fraud, abuse and waste in Medicare and Medicaid programs.

The Health Care Fraud Prevention & Enforcement Action Team (HEAT) was created in 2009 as a joint effort between the Department of Justice and the Department of Health and Human Services. The goal of HEAT was to crack down on healthcare fraud and abuse, while strengthening the integrity of the healthcare system. The Affordable Care Act authorized even more tools and resources to aid in these efforts.

During 2011, Medicare Strike Force teams were assigned to a total of nine cities. The strike force teams are a partnership between the Justice Department, the FBI and the Health and Human Services - Office of Inspector General. Using advanced techniques to analyze data, the teams charged 323 defendants who filed fraudulent Medicare billings of over $1 billion. The average prison sentence for each defendant was 4 years or more. 

Criminal charges related to health care fraud were charged by federal prosecutors against 1,430 defendants, the highest number ever charged in a single year. 21 criminal convictions relating to the illegal marketing of devices and products not approved by the FDA were also obtained. For the second year in a row, over $2 billion was recovered under the False Claims Act. These cases included illegal price schemes by drug makers, violations against self-referral laws and Medicare fraud by hospitals, among others.

HEAT and the Medicare Fraud Strike Force also hosted regional fraud prevention seminars around the country. These seminars offered information to help Medicare beneficiaries and seniors avoid being the target of a scam or fraud. Providers received free compliance training. The strike force teams and HEAT also urged state attorney generals to support additional education efforts. 

Also announced by the Centers for Medicare and Medicaid Services was a proposal to set time limits for collecting Medicare overpayments. The Affordable Care Act includes a deadline for the return of overpayments identified by providers. Both announcements reflect the ongoing efforts of the Obama administration to continue to protect taxpayer money by preventing health care fraud and waste.

Report Medicare fraud here.

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