The Most Frequently Asked Medicare Whistleblower Questions
by Brown LLC Whistleblower Law Firm,Class Actions and Injury LaThe
most experienced whistleblower attorneys at Brown, LLC are going to answer the
most frequently asked questions in this article. There are many individuals
with the knowledge of potential Medicare fraud, who seek answers to these
following questions before they take it to government officials.
What is Medicare fraud?
Medicare
fraud, in its simplest form, happens when an entity or individual, such as
hospital, pharmacy, healthcare agency or doctor deliberately submits a false
claim or misrepresents a fact to receive payment from the government health
insurance program.
Medicare
fraud also takes place when a person or a healthcare clinic that is not a
certified healthcare provider, however in certain way takes part in or gains
profits from the system for example: pharmacy benefit manager or health insurer
- deliberately causes someone else, often a healthcare provider or an innocent
patient - to submit false claims to obtain payment through government health
insurance programs.
A
third type of Medicare fraud takes place when a person or healthcare provider
beseeches, receives, pays or offers a payment – which could be anything of
value – to reward or induce referrals for services or products reimbursed
through government healthcare programs. These kinds of payments are referred to
as ‘kickbacks’ and are unlawful under Anti-Kickback Statue.
What sort of fraud can be reported as Medicare fraud?
To
provide protection for the integrity of Medicare program, all alleged Medicare
fraud could and must be reported to the government authorities. Medicare
providers or entities who involve in wrongdoing tend to do so in many ways. One
of the most common ways is by submitting claims for Medicare services,
including medical tests and treatments, that were never actually provided.
Involving in unlawful activities through services not provided could call for
“ghost patients,” that are either completely made up and non-existent, or are
patients who never actually received any services listed in the reimbursement
claim form.
Along
the similar lines, a Medicare provider may also do what is known as ‘upcoding.’
Health procedures are titled in the claim form under specific billing codes.
Upcoding takes place when the medicare provider submits their claim under a
billing code for more of a serious procedure that it actually was. Billing for
services that were never performed is to defraud Medicare. You can report it
straight to the government authorities.
How can you become a Medicare fraud whistleblower?
Medicare
fraud claims are pursued under the False Claims Act, which enables anyone with
the knowledge of potential fraud against government to obtain a lawsuit on
behalf of the government. As long as the suspected fraud is targeting a
government program, and is not publicly disclosed yet, the unlawful activity is
actionable under FCA.
To
become a Medicare whistleblower, you need to hire an experienced whistleblower
attorney, such as whistleblower attorneys at Brown, LLC. Lawsuits that are
brought under FCA have to follow an exclusive set of procedures, hence it is
important to hire a whistleblower attorney, who will navigate your way to win
the case and also obtain reward.
The
whistleblower attorneys at Brown, LLC, have extensive experience in filling
whistleblower claims and representing whistleblowers across the nation. Consult
with us today, and we’ll assure you of complete confidentiality.
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Created on Jun 10th 2021 12:13. Viewed 500 times.