The Most Frequently Asked Medicare Whistleblower Questions

by Brown LLC Whistleblower Law Firm,Class Actions and Injury La

The 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 393 times.


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