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Health Care Fraud

Fraud in the health care industry is rampant.  Government officials estimate that Medicare fraud costs taxpayers an estimated $60 billion a year, nearly 10% of the United States Department of Health and Human Services (HHS) $758.9 billion budget in 2010.  The majority of False Claims Act cases involve health care fraud.  According to testimony delivered by HHS Inspector General Daniel Levinson to Congress, the 1,300 investigations the agency initiated in 2009 alone have resulted in 500 Medicare fraud convictions and an estimated $3 billion in recovered funds.

Health care fraud and abuse practices include any and all knowing overcharges of any government funded health care program, including Medicare, Medicaid, TriCare, or any program administered by the Veterans’ Administration.

Common Health Care Fraud and Abuse Practices Include:

  • Bundling: Billing more for a panel of tests when a single test was requested
  • Unbundling:  Billing separately for procedures that should have been rendered at the same time for one price
  • Billing for services that were not rendered or that were not medically necessary
  • Upcoding: Inflating bills by using incorrect billing codes that justify a higher fee for treatment, or by claiming that services were rendered in an emergency situation when they were not, or were provided by a doctor when they were actually conducted by a nurse or resident intern
  • Billing for brand-named drugs when generic drugs are actually provided
  • Violations of the Anti-Kickback Statute, ie referring patients to another doctor or provider in exchange for compensation
  • Violations of the Stark Law, which prohibits self-referrals

 

If you have specific information related to the above-mentioned wrongdoings or similar fraud, contact us and we will analyze your case and provide step-by-step assistance with filing a whistleblower claim to stop the fraud.

Learn more on how to file a whistleblower suit.

 

 


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