Medicaid Fraud under the False Claims Act

Medicaid spends around $500 billion a year to treat the health problems of its recipients, primarily low income families, children and disabled individuals who have enrolled in the government insurance program.  An unknown portion of the money spent is lost each year to Medicaid fraud.  That number is most likely in the billions.

Doctors, nurses, patients and other health care professionals can help the government recover lost funds if they report evidence of Medicaid fraud to the appropriate agencies in the federal or state government.  Although there are several mechanisms to report health care fraud, including fraud hotlines, one of the most powerful is the False Claims Act.

The False Claims Act offers rewards to whistleblowers for the recovery of money lost due to Medicare and Medicaid fraud.  The whistleblower, known as a relator under the law, is entitled to bring a qui tam lawsuit to recover the funds lost by the government.  If money is recovered, the whistleblower receives between 15 and 30 percent of the proceeds of the litigation.

Recovery of State Portion of Medicaid Funding
Each state administers its own program with financial assistance from the federal government.  The state puts up about half of the funds from the program.  Around 30 states have adopted their own version of the False Claims Act to fight health care fraud.  If the Medicaid fraud took funds from a state where they have adopted a version of the False Claims Act, then the whistleblower may be able to receive a portion of the funds recovered from those states with a qui tam lawsuit.

Recovery of Federal Portion of Medicaid Funding
The Federal False Claims Act allows a whistleblower to recover the U.S. Government’s portion of the Medicaid funds taken by fraud.  The federal government provides approximately half of the funds spent by Medicaid.

To speak to a McEldrew Young whistleblower attorney about reporting Medicaid fraud, call 1-800-590-4116 for a confidential initial legal consultation.