Rule would boost Medicare whistleblower bounty to $10M

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A proposed rule to drastically increase whistleblower rewards paid for information leading to successful Medicare fraud actions to as high as nearly $10 million was proposed by the Department of Health and Human Services this week.

Secretary Kathleen Sebelius called the measure “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.”

Currently HHS offers fraud whistleblower bounties of 10 percent, up to $1,000, under its incentive reward program. Last year, HHS recovered more than $14.9 billion from fraudulent Medicare schemes, and in many of those cases the recovery stemmed from information provided by individuals. After the Internal Revenue Service saw an increase in fraud recovery after boosting its incentive awards, the HHS is proposing similar changes modeled on the IRS system.

The proposed rule would make a person providing specific information leading to the recovery of funds eligible to receive a reward of 15 percent of the amount recovered, up to $9.9 million.

The proposed rule would also add tougher standards for certain enrollment provisions, giving HHS increased authority to deny enrollment of providers affiliated with hospitals or other entities with unpaid Medicare debt, revoke billing privileges for individuals with felony convictions, and cut providers and suppliers who abuse billing privileges.

The rule would also expand the Senior Medicare Patrol program to help educate beneficiaries on the prevention, detection and reporting of Medicare fraud, waste and abuse.