Medicare Fraud Lawyer
A Medicare fraud lawyer represents whistleblowers who report providers and health plans that bill the Medicare program for care that was never delivered, wasn’t necessary, or was tainted by illegal payments. At Barrett Johnston Martin & Garrison, PLLC, we help the people who see these schemes from the inside turn what they know into a protected, properly filed case — one that can stop the fraud and reward them for stepping forward.
Medicare loses an estimated tens of billions of dollars a year to fraud. Because the program pays claims quickly and at enormous volume, the schemes are easy to hide and hard for the government to catch without an insider. That insider is often someone like you.
How Medicare Fraud Actually Happens
Medicare fraud rarely looks like a single dramatic act. More often, it’s a quiet, repeated pattern baked into how an organization operates. The schemes we most frequently help whistleblowers report include:
- Upcoding — billing for a more expensive service or a sicker diagnosis than the patient actually received, so the reimbursement is higher.
- Medicare Advantage risk-adjustment fraud — plans making patients look sicker on paper (through unsupported diagnoses or “chart reviews” that only add codes) to collect larger per-member payments.
- Durable medical equipment (DME) schemes — billing for wheelchairs, braces, or supplies that were never needed, never delivered, or generated through telemarketing and bogus prescriptions.
- Hospice and home-health fraud — enrolling patients who aren’t terminally ill or homebound to capture ongoing per-day payments.
- Telehealth and lab-test fraud — sham telemedicine consults used to order unnecessary genetic tests, blood panels, or equipment.
- Kickbacks — paying physicians, marketers, or recruiters for Medicare referrals, which makes every resulting claim false.
If what you’re seeing resembles any of these (or feels designed to wrongly extract money from the program), it’s worth a confidential conversation.
Medicare Fraud vs. Medicare Abuse ?
People often use the terms Medicare fraud and Medicare abuse terms interchangeably, but the distinction matters. Fraud involves knowing deception, such as billing for something the provider knows is false. Abuse involves improper practices that may not be intentional, such as inconsistent coding or overuse of services. The line isn’t always obvious from the outside, and you don’t need to know which side a situation falls on before you call. It’s our job to evaluate the facts and tell you whether there’s a knowing violation worth pursuing.
Your Role as a Medicare Whistleblower
The False Claims Act gives private citizens the power to sue on the government’s behalf when they have evidence of fraud against a federal program like Medicare. These are called qui tam cases, and they’re the government’s single most effective tool for recovering stolen Medicare dollars.
As the whistleblower (the law calls you a “relator“), you bring the case forward and provide the inside knowledge prosecutors need. You don’t pay to investigate it, you don’t go it alone, and you don’t have to confront your employer directly. Your lawyer carries that weight.
What You Can Recover and How You're Protected
If your case succeeds, you may be entitled to between 15% and 30% of the money the government recovers. Because Medicare fraud schemes often run for years and across thousands of claims, those recoveries (and the resulting whistleblower awards) can be substantial.
The law also shields you. Retaliating against an employee for reporting Medicare fraud in good faith is illegal, and if it happens, you may be owed reinstatement, double back pay, and additional damages. We pursue those protections aggressively alongside the underlying case.
There’s no cost to begin. We work on a contingency basis, so you owe nothing unless we win.
Why Whistleblowers Choose Report Healthcare Fraud
We concentrate on fraud against government health programs, so Medicare’s rules (Parts A through D, Medicare Advantage, the coding systems, the enforcement priorities) are the terrain we work in every day. We move carefully, keep your identity protected, and give you a straight answer about whether your information is strong enough to act on before you commit to anything.
Take the first step: request a free and completely confidential review of your Medicare fraud concern. You’ll speak with someone who understands the program, and nothing you share is disclosed without your consent.
Medicare Fraud Lawyer FAQs
Your case is filed under seal, so it stays confidential while the government investigates, and your employer isn’t notified by the filing. Full lifelong anonymity can’t be guaranteed in every case, but the seal process is designed to protect your identity, and we take every available step to keep it that way.
It’s when a Medicare Advantage plan exaggerates how sick its members are — adding diagnoses that aren’t supported by the medical record — so Medicare pays it more per patient. It’s one of the fastest-growing areas of Medicare fraud enforcement.
Yes. Many whistleblowers are still employed when they come forward, and the law specifically protects you from being fired or punished for reporting in good faith. We’ll talk through how to protect yourself before you take any step.
Between 15% and 30% of what the government recovers, depending on factors like whether the government joins the case and how central your information was. Given the scale of many Medicare schemes, awards can reach seven figures.
You don’t need a complete case — that’s what the investigation is for. But specific details and any documentation you lawfully have access to (without violating patient-privacy rules) make your case far stronger. We’ll guide you on what to gather and what to avoid.