Medicare Billing Fraud

Medicare fraud is purposely billing Medicare for services that were never provided or received.

Some examples of Medicare fraud include:

·         Double billing. This is charging a patient twice for a service. Sometimes it can occur due to clerical errors, and other times it is an intentional attempt to scam a patient into paying for care, medication, or services that were never provided.

·         Unbundling. This is where health care providers seeking to increase profits will "unbundle" the services, tests, or care they provided into smaller components, billing each smaller item separately to increase profits. Medicare often has special reimbursement rates for a group of procedures commonly done together, such as typical blood tests.

·         Upcoding. This is when medical bills are inflated by indicating that the patient experienced medical complications and/or needed more expensive treatments. For example, billing for advanced or complex services when only simple services were performed, billing for brand name drugs when generic drugs were given, listing treatment as having been for a more complicated diagnosis than was actually the case.

Billing Medicare for medical services is done using a complicated system of numerical codes that designate various procedures and diagnoses. Reimbursements are based on these codes.

Because different codes or code combinations may produce drastically different reimbursements from the government, there is an incentive to bill for a more serious and more expensive diagnosis or procedure.

Source: medicare.gov

Qui tam is a whistleblower lawsuit brought by an “informer” or “whistleblower” under a provision of the Federal Civil False Claims Act that allows private citizens to file a lawsuit on behalf of the United States Government alleging fraud, kickbacks, or misuse of government funds.  A party or individual who brings a successful Medicare suit receives as an award, a share in any money recovered.  Quit tam cases are brought under the False Claims Act, 31 USC § 3730(h) which protects private sector employees who assist in False Claims Act litigation in the Federal courts.  

---

Free Medicare Billing Fraud Consultation

---