Help Put a Stop to Medicare Fraud, Report to a Whistleblower Lawyer to Maintain Healthcare

In the day to day operations of in the medical profession, healthcare professionals frequently encounter challenging business relationships with their own employer, payers, vendors, pharmacies and other physicians, and many of them may raise fraud and abuse concerns. A supplier, vendor, pharmacy, medical device manufacturer, hospital and other stakeholders of the healthcare ecosystem all can commit Medicare fraud in many different ways. It could be an isolated event or more likely a widespread activity across an organization.

As a condition of participation the Medicare payments should suffice to ensure access to care without wasteful overspending. Although most physicians oppose outright fraud, the marketplace is rife with behaviors that produce inefficiencies, harm the patient and inflate the costs to the taxpayers.  Medicare Fraud and Medicaid Fraud are both government health care programs and the government is the people through taxation. There’s no precise mechanism to detect Medicare fraud which is why it is critical for the integrity of insiders to come forward with information about systemic fraud and why statutes like the False Claims Act (FCA) incentivize whistleblowers to received up to 30% of the government recovery was a whistleblower award. Federal healthcare fraud costs billions of dollars to the U. S taxpayers each year, in addition to putting beneficiaries’ healthcare at risk and each year several billion dollars are recaptured through the use of whistleblowers, thus generating hundreds of millions of dollars a year in whistleblower awards.. Estimates by Center for Medicare and MedicAid Services (CMS) indicate that the federal government may be defrauded more than $250 billion annually.

What all constitutes Medicare frauds?

Examples of Medicare fraud include knowingly billing for services at a level of complexity higher than required, ordering medically unnecessary tests or items and billing Medicare for no-shows or repeated visits that don’t occur. Sophisticated Medicare frauds involve conspirators submitting falsified records, and in some cases, involve patients also to create the false impression the government is paying for the legitimate healthcare services. Another type of prohibition is kickbacks where third parties are paid incentive money to enroll their Medicare patients into the providers facility.

Defrauding the federal government and its healthcare programs is illegal and may lead to fines, civil monetary penalties (CMPs) and imprisonment.  That’s why if you’re on the inside of the fraud, there’s the carrot to reporting in a possible economic award and there’s the stick, that is, the FBI may come knocking one day on your door asking questions to figure out how you fit into the scheme criminally.  You’re better off being ahead of the investigative curve, in fact, as a whistleblower you can be the head of the curve.

 Additionally, the professionals and organizations involved in Medicare and Medicaid frauds run the risk of being excluded from participating in all Federal healthcare programs and losing their professional licenses. The Center for Program Integrity (CPI) oversees the federal healthcare program integrity issues related to detecting, deterring and combating Medicare and Medicaid frauds.

Federal laws governing Medicare fraud and abuse include:

·         False Claims Act (FCA)

·         Physician Self-Referral Law (Stark Law)

·         Anti-Kickback Statute (AKS)

·         United States Criminal Code

In addition, Medicare and Medicaid regulations prohibit the fraudulent conduct addressed by these laws. When the Federal Government covers the items and services provided to Medicare and Medicaid beneficiaries, the federal fraud and abuse laws apply. When reimbursement methodologies are manipulated, it provides a room for fraud and it’s ultimately the program beneficiaries the U.S. taxpayers who had to bear the cost. It also results in expensive healthcare services for all, and expose the patients to the unnecessary and risky interventions.

Doing the right thing matters

As a Medicare whistleblower, you can play a vital role in protecting the integrity of the Medicare and Medicaid programs by reporting a Medicare Fraud. Program integrity includes targeting the causes of improper payments. However, not every improper payment is a fraud. Incorrect coding could be considered an error if inadvertent, or fraud if systemically done to increase the level of reimbursement. Ordering excessive diagnostic tests for the sake of billing would be fraud, especially if not logically related to the condition treatment is sought for. Bending the rules, such as upcoding or inappropriately billing practices may be actionable under the False Claims Act if done for economic gratification. Intentional deceptions, such as billing for services or supplies that were never rendered would qualify as a fraud as well

Hire the best whistleblower attorneys to maximize your chance of success

Brown LLC’s experienced Medicare fraud lawyers can analyze your issues and provide a legal evaluation of your whistleblower case or Qui Tam claim. Not every error or abuse qualifies to be a fraud. Being a law firm that focuses onr whistleblower cases, Brown LLC has the best whistleblower attorneys who are widely familiar with Medicare and Medicaid frauds, related regulations and views of CMS and OIG (Office of Inspector General) on its various areas. The law firm has an impressive record of recovering hundreds of millions for clients in addition to the taxpayers,  although past results don’t guarantee future successes.. Their Medicare fraud lawyers will evaluate your case factually and legally, and help you with reporting Medicare fraud the right way.

Protection for you from retaliation

Under the federal laws, whistleblowers of Medicare and Medicaid frauds are entitled to receive 15% to 30% of the amount of money recovered by the government due their blowing the whistle. The Qui Tam cases based on similar allegations are subject to dismissal if you’re not the first to file, so it is important to blow the whistle first and in the right way Brown LLC’s best whistleblower attorneys will file the case under seal to ensure that your identity remains confidential for a period of time, and you are also protected from retribution by your employer, such as demotion, verbal threats or physical injuries, and dismissal from service.

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Created on Dec 10th 2020 23:08. Viewed 671 times.

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