Wexler Boley & Elgersma is currently investigating claims that some companies and brokerages are committing Medicare Advantage fraud by violating federal regulations for the sale and administration of Medicare Advantage plans.
The federal government heavily regulates the sale of Medicare Advantage plans in order to protect vulnerable beneficiaries from fraudulent and deceptive tactics. Agents are required to pass a series of tests to ensure that agents are knowledgeable about the details of the plans and the prohibitions against waste, fraud, and abuse.
Despite these regulations, many brokerages and companies engage in unscrupulous and illegal tactics in direct contravention of the carefully constructed regulatory framework, particularly as it relates to the marketing and enrollment of beneficiaries in Medicare Advantage Plans. As just a few examples, the regulations prohibit:
- Contacting beneficiaries without their permission
- Door-to-door sales tactics
- Switching a beneficiary’s existing plan for the sole purpose of getting commission on the sale of a new plan (churning)
- Using false data to collect inflated fees
If you are a sales agent who is being asked to engage in Medicare Advantage fraud by your employer, you may have grounds to file a whistleblower lawsuit under the Federal False Claims Act.
Whistleblowers who report fraud to the government are granted strong protections under the False Claims Act’s qui tam provision to prevent discrimination and retaliation. The False Claims Act also incentivizes whistleblowers to report fraud by offering a percentage of any reward recovered from an ensuing lawsuit.
Wexler Boley & Elgersma is committed to seeing companies and individuals held responsible for their actions that involve fraud against the government and representing those private citizens who expose the fraud. Our attorneys and staff are intimately familiar with the challenges and nuances of whistleblower litigation and are here to help shine a light on fraud and corruption. Contact us today for a free and confidential evaluation of your claim.