How to Report Medicare & Medicaid Fraud (and Collect a Reward)

Hint: Calling the Medicare Fraud Hotline Won’t Get You a Reward

Google “How to Report Medicare Fraud” and in most states you will see the Medicare website at the top of the list. Medicare.gov recommends you report Medicare fraud by:  

How to Report Medicare & Medicaid Fraud (and Collect a Reward)

Do a similar search for How to Report Medicaid fraud and either this site or the state’s own Medicaid site appears first. Many states have their own hotlines since Medicaid is funded through a combination of federal and state tax dollars.

We certainly encourage would be whistleblowers to use these methods. However, if you are interested in earning a cash whistleblower reward, calling 1-800 MEDICARE or the local state Medicaid fraud hotline won’t get you a reward. (Some states can pay a nominal cash reward, usually $1000 or less.) The big percentage, high dollar whistleblower rewards are reserved for those few who choose to hire a lawyer and file a claim in state or federal court.

As soon as we mention “court,” many would be whistleblowers worry about the hassle and expense. Most whistleblower lawyers, however, advance the costs and fees necessary to bring these cases. They only get paid if they win.

They also do all the investigation.

To earn a cash whistleblower reward for Medicare fraud, claims must be filed under seal (secret) in federal court. Medicaid fraud claims can be filed in federal court and in 29 states, in state court. The procedures vary a bit state to state but most states follow the same formulas and protocols of the federal False Claims Act.

By filing a claim under the state or federal False Claims Act, you are eligible for a cash reward of between 15% and 30%. (Those numbers may vary a bit state to state.)

How to Report Medicare Fraud – Advantages of False Claims Act

The advantages of filing a Medicare or Medicaid Fraud case under the False Claims Act cases are several.

First, filing under the Act guarantees you eligibility for a reward. There is no guaranty of getting an award but if you are first to file, have inside information about fraud and the government uses your information, chances are good that you receive an award.

Absent a token payment available in some states, reporting through a hotline won’t get you a cash reward.

Using the hotlines also wont get you the full protections of the anti-retaliation provisions of the federal and state False Claim Acts.

Finally, because False Claims Act filings are prepared by lawyers, they typically go to the top of the investigations’ list.

Our Hotline is Different

When you report to our hotline, we send your information to a private attorney experienced in filing False Claims Act cases. (We don’t get paid any money for doing so.) They can help you decide if there is enough information to qualify for a reward or if you should just contact Medicare or the state Medicaid office directly.

Some people prefer contacting Medicare or the state Medicaid Fraud Control Unit (49 states, Puerto Rico, Washington DC and the U.S. Virgin Islands have one) because they can remain anonymous. Unfortunately, if you want to receive a reward, you can’t remain anonymous forever. (Generally, you can remain anonymous for at least one year giving you time to find a different job.) Once again, we can help you decide.

Since being enacted in the 1860’s (during the U.S. Civil War), the False Claims Act has collected over $56 billion for taxpayers, most of that since 1986.

Some of the largest cases to date have been healthcare fraud cases, often involving pharmaceuticals, hospital chains or illegal kickbacks.

False Claims Act Medicare Fraud Claims Pay Cash Rewards

Most whistleblower report Medicare fraud through state and Medicare hotlines run by the government. Those hotlines have an added bonus in that you can report anonymously. If your only goal is to stop fraud or if you must remain anonymous, calling 1-800-MEDICARE or reporting directly to states makes the most sense.

If you want a reward, however, contact our hotline.

Under the False Claims Act, whistleblowers can receive between 15% and 30% of whatever the wrongdoers pay the government. The money comes from the wrongdoers, not taxpayers. In some states, the percentages may vary a bit. Two states, Illinois and California, have whistleblower reward statutes that pay for inside information about privately funded healthcare fraud (e.g., Aetna, Blue Cross, Anthem, Molina, etc.).

Remember, the feds can always pay rewards for Medicare fraud no matter where you live. Medicare is funded with federal tax dollars, not the state.

The feds can also pay rewards on the federal match of Medicaid, once again in any state.

To receive a reward for the state match of Medicaid, you must be in a state that has a state Medicaid fraud whistleblower reward law. Those states are:

Some of the largest whistleblower rewards to date have been paid in Medicare fraud cases begun by whistleblowers including $ 3 billion recovery against pharmaceutical company GlaxoSmithKline. Four insiders turned whistleblowers shared a $250,000,000.00 reward.

In a for profit hospital case, HCA (the largest private hospital company in the United States) twice paid whistleblowers $150 million rewards. Another for-profit hospital company, Tenet Healthcare Corp, has been labeled a serial offender of the False Claims Act.

Healthcare fraudsters are growing more sophisticated by the year. At the same time, state and federal budgets are frozen meaning fewer auditors and special agents to investigate Medicare and Medicaid fraud complaints. (Wyoming only has a staff of four!) Now, more than ever, we rely on whistleblowers – ordinary healthcare workers with inside information about fraud and corruption – to step forward.

Whistleblowers are the New American Heroes

If you simply want to remain anonymous and aren’t interested in a reward, feel free to call 1-800-MEDICARE. If the case only involves Medicaid, you can contact your state Medicaid Fraud Control Unit as well.

If you are interested in collecting a cash reward and best protecting yourself from illegal retaliation, contact our hotline number. All inquiries are kept confidential. We do not charge for our services.

For more information, contact one of our operators toll free at 888.742.7248. You can also contact us online.


Medicaid Fraud Hotline: 888.742.7248 or Report Online
and claim reward