ATTORNEY NEWSLETTER

Department of Justice Expands Investigation Lead By Whistleblower

Allegations of Large-Scale Medicare Fraud

The Department of Justice (DOJ) recently expanded its investigation of the Medicare Advantage Plan thanks to the efforts of a Medicare whistleblower. The whistleblower case (also known as a qui tam) began as an investigation of a single carrier whose “risk adjustment reimbursement” process looked suspect. The whistleblower was an insurance company executive with credible information of violations of the False Claims Act, on an enormous scale. The False Claims Act imposes liability on individuals and corporations (typically government contractors) who defraud the government by overbilling or some other scheme. Between 1987 and 2015, the government recovered over $50 billion under the Act, and a significant part of the recovery came from whistleblower or qui tam cases.

In this case, the whistleblower claimed the insurer had fraudulently collected “hundreds of millions—and likely billions—of dollars” in Medicare Advantage risk payments by claiming patients were sicker than they really were. Private insurers offer Medicare Advantage Plans and those plans cover Medicare benefits for millions of eligible seniors. In fact, those plans cover over 20 million Americans and claim a big slice of the $600 billion paid out every year by the federal government for Medicare. Needless to say, the stakes here are enormous. Whatever recovery the government achieves, and whatever billing practice reforms come about as a result, it will be thanks to a single Medicare whistleblower.

The whistleblower stands to be rewarded for coming forward. In the past six years, the government paid out over $3 billion to individual whistleblowers as awards for information. Reporting fraud against the government, including Medicare and Medicaid fraud and tax fraud, can pay. If you believe you have credible information of fraud against the government, consult a professional who can assess your information and assist you in gathering what you need to approach government investigators or bring your own whistleblower or qui tam lawsuit in California.

Contact Us

If you have information regarding Medicare or Medicaid fraud, or tax or securities fraud, and are looking to be a whistleblower in Alameda County or in any California county, contact the Evans Law Firm elder attorneys at (415) 441-8669, or by email at info@evanslaw.com. Our attorneys have experience with complex qui tam or whistleblower cases, and cases against large insurance companies. We can help guide your case through a jury trial or toward an equitable settlement. We also handle cases involving physical and financial elder abuse, nursing home abuse, whole life insurance and universal life insurance, and indexed, variable, and fixed annuities.