Medicare Whistleblower

Whistleblower Definition

This site is full of information on whistleblower definition, how to become medical whistleblower or whistleblower in general. We hope you will find it useful and that it will help you define wistleblower term in practical way.

Medicare Fraud results in billions of dollars in illegitimate payments every year. The Federal Government is incapable of stopping all of the fraud. Many times the cases they do investigate turn out not to be fraud related. Due to the enormity of the situation, Medicare whistleblowers are the first line of defense in the effort to curb fraud.

How to Report Medicare Fraud

Before reporting potential fraud, it is important to make sure that you it is an actual case of wrongdoing.

If you believe that there are charges that have been made on your behalf that are incorrect, the first thing you should do is call your healthcare provider. Ask them about the charges. It is possible that it was simply an oversight, and they will be glad you brought it to their attention.

If, however, after you have spoken with them, you are not satisfied that they are going fix the problem, and you believe it to be a legitimate case of attempted fraud, then you should call 1-800-MEDICARE and report the situation.

Laws Concerning Medicare Fraud

The DOJ and HSS have been working very hard to establish stiffer penalties for those found guilty of perpetrating Medicare Fraud. There are a number of different laws regarding these penalties and it is a good idea to familiarize yourself with these laws in the event you believe that fraud is taking place. Knowing what a physician or health care provider can and cannot do is an important part of protecting against abuse.

Becoming a Medicare Whistleblower

When someone reports Medicare Fraud, they are often called a “whistleblower.” This simply means that they are alerting the Government to a potential violation. Many people, especially seniors, are hesitant to blow the whistle on potential fraud because of the fear of retaliation, or because they fear losing their care.

It is important to know that you can call the Office of Inspector General (OIG) and give an anonymous tip. No personal information will be entered into the system that could be traced back to you.

Rewards for Whistleblowers

There is also a monetary reward for tips that lead to the successful prosecution of Medicare fraud. Medicare whistleblower reward settlements are dependent on certain conditions being met. These are:

  1. You must report specific allegations.
  2. The suspected fraud must be confirmed by one of these three:
  • Program Safety Contractor
  • Zone Program Integrity Contractor
  • Medicare Drug Integrity Contractor

The allegation must then be referred to the Office of Inspector General as part of a case.

  • You must not be an excluded individual. (You didn’t participate in the fraud)
  • The person or group you are reporting is not already under investigation.
  • Your report leads to the recovery of at least $100 of Medicare money.
  • Being Part of the Solution

    Fighting Medicare fraud is an important part of safeguarding our healthcare for future generations. Because Medicare is paid for almost exclusively by tax revenue, fraud hurts everyone. If you suspect that something has happened illegally, then it is your duty to blow the whistle. Doing so makes you part of the solution…