Rewards for Medicare Fraud Information

Rewards for Medicare Fraud Information

Rewards for Medicare Fraud Information:  HHS Proposes Larger Whistleblower Rewards for Medicare Fraud

Based on a proposed rule by the Department of Health and Human Services (HHS), whistleblowers who assist in uncovering cases of Medicare fraud could soon see greater rewards than ever before. Up to a maximum of $9.9 million in some extreme cases, although most awards will be in the tens of thousands or hundreds of thousands of dollars.

The newly proposed modifications to the Medicare Incentive Reward Program (IRP) will give whistleblowers at least 15% of all monies up to $66 million that are recovered from Medicare fraud cases, in return for useful specific information leading investigators to Medicare fraud. The IRP is designed along the lines of a similar IRS program, which has proved to be extremely successful in recovering tens of millions of dollars from tax cheats every year. The IRP was initiated by the Health Insurance Portability and Accountability Act (HIPAA), which empowers the HHS secretary to set up a reward system for individuals who report Medicare fraud.

HHS is hoping the proposed rule will create a huge increase in tips to Medicare fraud, by increasing the incentive for people with knowledge of potential fraud to report information. The increase in available information should improve the Department’s ability to detect new fraud schemes, and to ensure that Medicare cheaters don’t enroll in or maintain enrollment in the Medicare system.

While the proposed rule, as written, would increase the amount of the reward from 10 percent of the amount recovered to 15 percent, HHS is also asking for comment with regard to offering rewards of more than 15 percent, up to a maximum of 30 percent.

The rule doesn’t just increase the size or rewards under the IRP; it would also authorize enrollment denials under certain situations, which they hope will strengthen the Medicare provider enrollment process. For instance, a medical supplier who previously owned a different provider who owes Medicare money, or whose Medicare enrollment was revoked would not be eligible.

A large number of Medicare fraud cases are brought because whistleblowers make federal prosecutors aware of the circumstances. When that happens, under the False Claims Act, that whistleblower may be entitled to compensation from the restitution they receive. Under the IRP proposed by HHS, that amount could mean tens of thousands of dollars or more to that whistleblower. If you have knowledge of any sort of Medicare fraud under the False Claims Act, you may be entitled to compensation if you expose them. Contact the Texas Medicare Fraud False Claims Act Attorneys at Hill Law Firm to help you.


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