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Medicare/Medicaid fraud whistleblowers could earn nearly $10 million under proposed rule

The Department of Health and Human Services might not have the manpower to deal with all the cases the rule will bring

A new rule announced by the Department of Health and Human Services (HHS) on Wednesday would increase whistleblower payouts for people who shed light on healthcare fraud.

The Centers for Medicare and Medicaid Services, a division of HHS, proposed raising the ceiling for such payments from the current cap of $1,000. Under the new rule, if it is approved, whistleblowers could receive up to 15 percent of any recovery resulting from their tip, up to $9.9 million.

The proposed rule is a "signal to Medicare beneficiaries and caregivers, who are on the frontlines of this fight, that they are critical partners in helping protect taxpayer dollars,” said HHS Secretary Kathleen Sebelius in a statement.

As with any whistleblower program, the proposed rule raises concerns that the money will be a strong incentive for people to report to the government first, instead of going through internal channels at companies to report suspected Medicare or Medicaid fraud.

Thomson Reuters reports that another pressing concern is that HHS simply won’t have enough manpower to sift through the tens of thousands of cases that are likely to result from the rule change. Experts are predicting a backlog of cases that could slow down the finding of fraud.

 

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