Medicare Fraud Whistleblower Attorney
Medicare fraud is a significant problem that can cause lots of damage. People who knowingly engage in fraud can cost taxpayers billions of dollars and impact the health and welfare of beneficiaries. Knowing what constitutes Medicare fraud can go a long way toward protecting the integrity of the system and preventing unnecessary suffering. If you’re concerned about fraud, an experienced Medicare fraud whistleblower attorney can help.
Most doctors try to cooperate fully with the Medicare system, only requesting services that their patients truly need. The risk of fraud increases when doctors submit their patients to unnecessary tests or treatments. These services can increase the claims submitted to the Medicare system, resulting in money being spent at the expense of others who may truly need help.
If you are concerned about potential Medicare fraud in Florida, contact the knowledgeable Medicare fraud whistleblower attorneys at Feldman Law Group at 1-877-946-8293.
What Is Medicare Fraud and Abuse?
Medicare fraud typically includes any of the following:
- Submitting false claims to obtain money from the Medicare system
- Obtaining kickbacks for services that receive Medicare funding
- Making unnecessary referrals for specific designated Medicare services
Anyone can participate in Medicare fraud, whether they do so as an independent person or as a group or entity. Examples of fraud include the following:
- Billing for services that weren’t performed
- Issuing claims that exceed the complexity of services provided
- Ordering unnecessary services or items for patients
- Paying for referrals of Medicare customers
- Charging for missed appointments
Defrauding the government of funds exposes individuals and groups to potential criminal, civil, and administrative liability.
The difference between Medicare fraud and Medicare abuse depends on the level of knowledge of the perpetrator. Abuse occurs when incorrect billing is sent to Medicare or unnecessary services are performed without the intent to defraud the government.
Abuse of the Medicare system can lead to criminal or civil liability for providers.
What Medicare Fraud and Abuse Laws Exist?
The government has created several fraud and abuse laws relating to Medicare. These include:
Federal Civil False Claims Act (FCA)
The FCA levies civil liability on anyone who knowingly submits a false or fraudulent claim to the federal government. Intent to defraud is not required to violate the Civil False Claims Act.
Anti-Kickback Statute (AKS)
The Anti-Kickback Statute makes it illegal for a provider to solicit or receive remuneration for patient referrals or to specifically generate business from Medicare customers. Once remuneration is received, the provider violates AKS.
Penalties for violating AKS may result in fines, imprisonment, or exclusion from the federal healthcare program.
Physician Self-Referral Law (Stark Law)
The Stark Law prohibits physicians from referring patients for treatment for Medicare reimbursable services when they have a financial relationship with the provider.
Criminal Health Care Fraud Statute
The Criminal Health Care Fraud Statute prohibits knowingly and willfully executing a scheme to obtain healthcare benefits to defraud a program or obtain money or property owned by a healthcare benefit program. Penalties can include fines or imprisonment.
Where Is Medicare Fraud Found?
Our Skilled Medicare Fraud Whistleblower Attorneys Know How to Fight Fraud Effectively
Medicare fraud can occur at any physician’s office, hospital, or nursing home. All medical settings have the potential to be involved in Medicare fraud. An individual or employee who believes that fraud may be occurring is obliged to report the fraud to the federal government. The government can then investigate the fraud to determine whether any activities have occurred that violate federal law.
In addition, our experienced Medicare fraud whistleblower attorneys can assist in helping to report the fraud to the appropriate organization and protect the whistleblower’s rights.
Is There a Prevalence of Medicare Fraud in Nursing Homes?
When a Loved One Has Been Defrauded, Our Experienced Attorneys Can Help
Nursing homes are particularly known to be sources of Medicare fraud. As some of their patients receive Medicare, it is not uncommon for healthcare providers to overbill or charge for services that were not actually provided to their senior patients.
In addition, the elderly who live in these homes may no longer have their full mental capacities. As such, they may be subjected to medical services that they don’t realize are unnecessary or billed for services they never received.
The situation becomes especially difficult when elderly patients do not have a family or friends to check up on them and ensure they are receiving appropriate treatment. Family members are often the first to realize when an elderly patient is not being taken care of. In addition, the family is in the best position to review a patient’s billing statements and question services provided, medications given, and equipment assigned.
If you are reviewing an elderly loved one’s medical bills and notice discrepancies in services or medications provided, contact the billing administrator or healthcare provider immediately to gain clarity. It may be an error or a false claim, or it could be legitimate services that were provided. If you know of your loved one’s condition and the treatment does not make sense, it is highly advisable to question it as soon as possible.
Frequently Asked Questions for a Medicare Fraud Lawyer
Because Medicare fraud is such a complex topic, you may naturally have questions about it. Here are some of the most common questions our Medicare fraud lawyers hear.
How do I report Medicare fraud?
At Feldman Law Group, a Medicare fraud lawyer in Florida can assist in preparing documentation of Medicare fraud and identify the correct organization to report the fraud to. Call us at 877-946-8293 to learn more.
If you wish to directly report possible Medicare fraud, you may also reach out to the Office of the Inspector General at 1-800-HHS-TIPS.
What happens if I am accused of Medicare fraud?
Being accused of Medicare fraud can be very troubling to a physician or healthcare provider. The best way to avoid being accused of Medicare fraud is to carefully review claims submitted to Medicare to ensure that they accurately reflect services or treatments provided. It’s important to also keep track of reasons that specific tests or medicines were suggested, in case these services are questioned in the future.
Proper bookkeeping is essential when it comes to claims submitted to Medicare. You should compile thorough documentation for services provided and money paid for a Medicare claim. If you’re not sure about a drug that you prescribed or a test that you referred a patient for, you should report the most conservative information you have to Medicare.
People cannot be charged with an offense for underbilling Medicare; it only becomes a problem when the system is overcharged.
What happens in a Medicare fraud lawsuit?
A Medicare fraud lawsuit is typically brought by the U.S. Department of Justice after a significant investigation by participating agencies, which can include the United States Department of Health and Human Services, the Federal Bureau of Investigation, the Drug Enforcement Administration, the Internal Revenue Service, and others.
If criminal prosecution is found to be appropriate, a criminal complaint may be issued, identifying the perpetrators and outlining their various alleged offenses. Depending on the results of the trial, the judge may order jail time, fines, or other forms of restitution to be paid.
Civil prosecution may also be pursued. If a defendant is found guilty of civil Medicare fraud, they may be subject to significant fines, sometimes up to three times the amount of the fraudulent claims submitted. Convicted defendants may also be permanently barred from participating in the Medicare program as a provider.
A Medicare fraud lawyer should be consulted for assistance in defending against a Medicare fraud lawsuit.
As a patient, what can you do about Medicare fraud?
It’s important for patients who are on a Medicare plan to check provider statements that are sent to them after they receive care. Doing this can allow a beneficiary to notify the provider immediately if there are mistakes in their bills.
Common errors – whether intentional or unintentional – can include the following:
- Payments for medical services not received
- Dates of service that differ from the dates you actually received the service
- Payments for ambulance transportation that wasn’t provided to you
- Duplicate payments for the same service
Caution should also be exercised if a provider advises:
- A test is free but your insurance number is required for recordkeeping
- The more tests are given, the “cheaper” they are
- Your insurance will cover any services or equipment
As a patient, how do I report Medicare fraud?
First, you may contact the billing administration department of your healthcare provider to clarify any mistakes in your billing. If the billing is clearly fraudulent, you should notify the Office of the Inspector General at 1-800-HHS-TIPS and get in touch with one of our knowledgeable Medicare fraud lawyers.
As an employee, what can I do about Medicare fraud?
If you are an employee of a healthcare provider and believe that laws that protect Medicare are being broken, it is important to report your knowledge to the Office of the Inspector General at 1-800-HHS-TIPS. In addition, you can reach out to a Medicare fraud whistleblower attorney who can protect your employment rights if your employer attempts to retaliate against you.
A whistleblower lawyer can protect employees from retaliation or harassment attempts by their employer. They may also seek compensation for whistleblowers who report Medicare fraud.
Employees are often the first ones to realize that Medicare fraud is occurring, especially if they have a medical background. Astute employees will recognize when a recommended medical service seems frivolous or if a patient is unlikely to respond to a treatment. If they become familiar with a patient, they may be more likely to know what the patient truly needs and to question services that don’t make sense.
Medical coders in the billing department who are cognizant of Medicare fraud can also question services that seem excessive or duplicate entries for the same service. Oftentimes, medical coding is clerical work that can be done without much training. Reputable healthcare providers should ensure that medical coders and billing administrators receive appropriate training and know when to question documented services before submitting them for repayment from Medicare.
If you have knowledge of a scheme to commit Medicare fraud, you should reach out to our Medicare fraud lawyers for guidance.
What does a Medicare fraud lawyer do?
A Medicare fraud lawyer may serve several purposes. They can work with the government to investigate healthcare providers who have allegedly committed Medicare fraud. They may also represent physicians or healthcare providers who have been accused of healthcare fraud.
In this case, they may work as a liaison between the provider and the government, providing documentation for claims submitted and all other supporting evidence requested.
A Medicare fraud lawyer may also work on behalf of a whistleblower who reports the alleged fraud. In this case, they would protect the worker’s rights and shield them from potential retaliatory actions or harassment.
Is there a Medicare fraud whistleblower reward?
There is a Medicare fraud whistleblower reward, but only if specific steps are taken. If even a single step is missed, a Medicare fraud whistleblower reward will be denied.
First, you must hire an attorney to file a Medicare fraud lawsuit against the healthcare provider that is committing Medicare fraud. Convincing the government to take up a lawsuit against a healthcare provider requires clearcut knowledge of a scheme in place. It is not enough to simply report circumstantial evidence to a hotline.
Typically, rewards are issued to employees who have inside knowledge of a scheme taking place or who are offered the chance to be a part of a fraud scheme but decline. The largest rewards are paid to these individuals, who are usually able to provide documentation and evidence that Medicare fraud is taking place.
Secondly, your attorney must be the first to file a whistleblower reward application. The Department of Justice (DOJ) may only pay a single reward per uncovered scheme under the guidelines of the FCA.
The allegations must not be the subject of news or media reports already, unless the whistleblower is considered to be an “original source” of the public disclosure. There are exceptions, such as if a whistleblower has additional knowledge that can significantly contribute to the allegations.
Finally, the defendant must repay the government an amount to settle the Medicare fraud lawsuit. The amount given to the whistleblower as a reward will be between 15 to 30% of the amount collected from the defendant.
However, if the government does not collect any funds, no reward will be available to the whistleblower. It is not typically worth the whistleblower’s time to report fraud with a lack of clear-cut evidence of a widespread scheme to commit Medicare fraud.
Why Choose Feldman Legal Group?
At Feldman Legal Group, our experienced Medicare fraud lawyers are committed to fighting for the rights of victims in Florida and Georgia. With over 25 years of experience, a long track record of success, comprehensive knowledge of the insurance industry, and a passion for the clients that we serve, we know what it takes to pursue justice.
If you are thinking about reporting a Medicare fraud scheme in Florida, contact the experienced legal team at Feldman Legal Group at 1-877-946-8293.