Whistleblower’s Guide to Medicare Part D Fraud

Have you witnessed your employer participating in Medicare Part D fraud? If so, you may be needed to serve as a whistleblower. Whistleblowers play a crucial role in protecting both patients and taxpayers from the consequences of fraud. They may be very well compensated for their participation.

Medicare Part D Fraud is covered by the False Claims Act (FCA). This legislation was passed to prevent fraud against the government. One of its key mechanisms for discovering fraud is a qui tam provision that rewards whistleblowers with a portion of the funds that are recovered.

Before you blow the whistle, you should consider speaking to a lawyer. A lawyer can help you understand whether the activity you’ve witnessed is considered fraud and how to move forward.

Before you speak to a lawyer, it may help you to understand Medicare Part D fraud better. Below, you can learn what Medicare Part D is, what activity is criminal fraud, and what real-life examples exist of this fraud

Medicare Fraud

Medicare fraud is a broad term that covers any action that results in the defrauding of the Medicare public health insurance program. As one of the largest insurance programs in the US, it makes billions of dollars in disbursements every year to providers that include doctors, hospitals, pharmacies, hospices, and drug manufacturers.

The amount of money and transactions involved can make fraud tempting and difficult to detect. However, the government has many tools for detecting and reclaiming money lost to fraud—even years after the fraud was committed.

One of the ways the fraud is detected is through the use of the False Claims Act and the incentives that law offers to whistleblowers who are directly employed by the providers who receive Medicare funds.