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A detailed insight into the Medicare and Medicaid fraud whistleblower programs
by Brown LLC Whistleblower Law Firm,Class Actions and Injury LaMedicaid and Medicare misconducts are amongst the most common
forms of fraud, costing millions of dollars every year. Since 2009, the Justice
Department had recovered over $30 billion related to the False Claims Act
concerning misconducts against the federal health care laws.
What is Medicaid and Medicare Fraud?
Medicaid and Medicare fraud occurs when a nursing home,
hospital, or a healthcare clinic bills the state or federal government for
services and supplies that were actually never offered. Medicare misconducts
are unbridled and they often cost the taxpayers billions a year. They also
affect susceptible populations who depend on Medicare to get major treatments.
Types of Medicaid and Medicare misconducts
Medicaid and Medicare misconducts could take a variety of
forms, including:
Upcoding
Upcoding takes place when a nursing home, hospital, or a
private healthcare clinic bills Medicare or Medicaid for services and supplies
that are costlier than the services actually offered or performed.
Overbilling
Overbilling for healthcare services or medication happens
when a hospital, nursing home, or a private doctor’s clinic bills Medicare or
Medicaid inflated costs for services and medications or bills for services or
medications it never provided. For instance, a patient undergoes a surgery and
receives a bill with the inclusion of charges for the surgery, surgical tools,
and even the tray used during the procedure. This would make an ideal case of
overbilling.
Kickbacks
The anti-kickback statute is to prohibit paying, receiving,
soliciting, or offering anything of value that could possibly reward or induce
referrals for services or items paid for by the healthcare providers. For
instance, a chemist company might try to ensure doctors prescribe only their
company’s drugs by offering them trips, payments, or anything of value.
Superfluous medical procedures
A doctor might order superfluous medical procedures where
they have ordered expensive treatment which is not medically indispensable.
Procedures might be superfluous if they are unusual in the treatment of the
patient with a specific condition; in case a procedure is performed more often
than required; or if a treatment is performed which is prohibitively expensive
than an optional treatment that could have attained the similar results.
Unnecessary treatments, expensive surgeries might account for as much as 20% of
operations in some specialties, such as spinal surgeries, and certain cardiac
procedures.
Medicare and Medicaid fraud attorneys at Brown, LLC have had helped clients
in cases ranging from long-term care misconducts, DRG false claims, coding false
claims, outpatient APC false claims, Medicare kickback violations, Stark law to
PPS false claims. Medicare has been expanded and amended several times since it
got introduced in 1965. Although efforts have been put to mitigate Medicare
misconduct, it still has a long way to go. Medicare misconducts have been
costing taxpayers millions of dollars and using the qui tam programs of the
False Claims Act, a major portion gets returned to the government.
The abolition of third-party payments straight to the
healthcare providers in preference to reimbursement of the beneficiary would
help; however, there will still be many cracks. Medicare and Medicaid fraud can
only be disclosed by Medicare fraud whistleblowers. And, it is also imperative
that the False Claims Act’s Qui Tam continues to be obtainable as an
encouragement for Medicare fraud whistleblowers to report.
For years, Medicare and Medicaid fraud whistleblower program
have brought substantial returns to the government. Many of such Medicare and
Medicaid fraud claims and the consequent returns had been made possible by
courageous whistleblowers coming forward to report these frauds. Using Qui Tam
programs under the False Claims Act, these people have been able to prevent
misconduct and also have collectively been awarded millions for their part in
bringing the frauds to justice.
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Created on Jul 7th 2021 13:49. Viewed 606 times.
