Medicare and Medicaid Fraud under the False Claims Act

Information Provided by a Medical Whistleblower Attorney

Medicare and Medicaid are government programs with budgets in excess of the hundreds of billions of dollars. The sheer size of these programs leaves them highly vulnerable to fraud. Improper billing practices, misrepresentations of medical procedures, and falsified prescription drug data cost taxpayers hundreds of millions of dollars every year.

Medical whistleblower settlements under the False Claims Act are the single most effective weapon the U.S. government has to combat this fraud and, as such, the government offers compensation to whistleblowers for saving them money. If you work in the healthcare industry and are aware of fraud perpetrated through Medicare or Medicaid, contact a whistleblower attorney at Mike Love & Associates, LLC and help the government combat this serious problem. Your call is confidential and your job is safe; there is no risk in calling us now.

Common Medicaid and Medicare fraud cases include:

Bundling and Unbundling Medicare and Medicaid Services

One of the most frequent areas of fraud in Medicare and Medicaid Services has to do with the “bundling” codes used for requesting reimbursement of medical services. This process requires billing of certain procedures and services together as a “bundle”, and has very specific guidelines.

Fraud occurs when a charge is part of a bundle, and is then “unbundled” so reimbursement can be requested separately for the same procedure. This can also occur when a patient only needs one part of a bundled procedure, but the reimbursement request is for the entire bundled service.

Upcoding

“Upcoding” is another serious fraud issue with Medicare and Medicaid. Medical procedures in these systems have codes that align a procedure which the level of reimbursement. Upcoding fraud is when someone uses a code that calls for a higher reimbursement on a less expensive or incomplete procedure. These are intentional errors designed to obtain higher payment.

Treatment Fraud

Various types of Medicare fraud and Medicaid fraud occur under the guise of legitimate treatment, including:

• Billing for services that were never provided
• Rendering and billing for services that have no medical value
• Ordering treatment and tests that are unnecessary
• Misuse and falsified records for prescription drugs
• Providing services that fail to meet the quality of care standard

The False Claims Act is the government’s strongest tool to combat health care fraud and abuse in the Medicare and Medicaid programs.

In an era when the long-term solvency of these programs is in doubt, it is more imperative than ever that medical whistleblowers use the law fight corruption. Contact a whistleblower lawyer at Mike Love & Associates, LLC to take the first steps in stopping this costly area of fraud and to find out if you have a Qui Tam case.