As Medicare Cuts Loom, Whistleblowers Can Soften the Blow

05/23/2013 // Whistleblower Law Firm // Jeffrey F. Keller // (press release)

(Whistleblower News) – When the Obama administration released its proposed 2014 budget, the Department of Health and Human Services saw a boost of nearly $4 billion over 2013. But not all HHS programs fared equally, and the news was grim for the department’s Medicare program. The new budget calls for $370 billion in Medicare cuts over the next decade, citing a variety of ways to bring down spending, including negotiating better prescription drug prices, reducing management costs, and having higher-income beneficiaries pay more. But one method — reducing fraud — holds particular potential, thanks to the strength of the nation’s key whistleblower law, the False Claims Act.

HHS’s Medicare program is the nation’s largest health insurer, processing more than 1 billion claims per year. But as with all large government programs, fraud has been a significant and troubling drain on the program. Whistleblower statutes like the False Claims Act have proven to be highly effective in exposing and reversing such fraud, providing incentives for those with knowledge of wrongful behavior to speak out about it.

Under the False Claims Act, whistleblowers can file suit against those they believe to have filed false claims for payment (like payments for Medicare services), which defrauded the federal government and receive a share of the amount the government ultimately recovers. The process has proven remarkably successful, with FCA whistleblowers spurring the recovery of more than $30 billion in fraud-tinged funds since the statute was substantially modified in the 1980s.

“Whistleblowers have already demonstrated that they can be a highly effective means to combat fraud,” says Jeffrey F. Keller, a founding partner at Keller Grover, a nationally recognized labor and employment law firm, and a veteran whistleblower lawyer. “By helping to tackle Medicare fraud, they can help taxpayers in two vital ways: recovering funds that never should have been paid; and easing the pressure to make painful, unpopular cuts to Medicare.”

The more effective fraud prevention is, the less urgent — or deep — Medicare cuts become. “Put simply, whistleblowers can be a highly effective way to keep Medicare funding where it needs to be to promote the health of Americans,” says Keller.

What is needed now, notes the whistleblower lawyer, is to get the word out. “We have this remarkably effective law, this means to both reduce fraud and guard vital services, but it is still largely unknown,” says Keller, whose firm has offices in Los Angeles and San Francisco. “There are so many potential whistleblowers out there — people who know that something is amiss and can help us correct it. We need to tell them about the provisions and incentives of statutes like the False Claims Act — how they can blow the lid on Medicare fraud and benefit both themselves and the rest of us in the process.”

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