Medicaid Fraud

Medicaid is a state and federally funded health care program that uses taxpayer dollars to cover the medical needs of low income individuals. When health care employees take advantage of this program by submitting false claims for financial profit, all taxpayers suffer. If you believe your employer is submitting false claims to Medicaid, you may be entitled to significant compensation.

There are a number of laws covering Medicaid whistleblowers. The Virginia Fraud Against Taxpayers Act (VAFTA) allows whistleblowers to file a lawsuit on behalf of the government and share in a percentage of the recovery. Any person who commits the following may be in violation of the VFATA:

  • presents a false claim for payment;
  • makes a false statement material to payment;
  • conspires with others to defraud;
  • fails to return money or property of the state;
  • delivers a receipt for a state program without knowledge of its accuracy;
  • conceals or decreases an obligation to a state program.

Employees are often concerned their employer will fire them or decrease their pay if they come forward with an allegations of fraud. Fortunately, there are a number of laws that protect employees. The VAFTA protects an employee from the retaliatory conduct of an employer. The employee is protected from being fired as well as any negative conduct, whether actual or threatened, due to the employee’s whistleblowing. Should prohibited retaliation occur, the employee may be entitled to reinstatement, back pay, special damages, and attorney’s fees. The new Virginia whistleblower statute offers further protection for these whistleblowers as well as the federal False Claims Act.

We already know a wide variety of Medicaid fraud is happening. Fraudulent referral systems for hospitals and surgeons. “Pill mill” doctors who fraudulently bill for prescription opioids. Marked-up billing for ambulance services.  Nursing home administrators seeking reimbursement for services they did not provide.

Health care professionals are in the unique position to gain inside knowledge of Medicaid fraud. The government provides cash incentives and powerful protections for whistleblowers who are willing to come forward. If you suspect your employer is participating in a scheme to profit from Medicaid, we encourage you to contact our office.

Bo Frith