MEDICARE FRAUD

MEDICARE FRAUD IS A CRIME

Defrauding Medicare means defrauding the government, and if you know of fraud against the government, due to Medicare billing fraud, you could help the government collect damages.

 

Your help, in the successful prosecution of a Medicare-based Qui Tam case, could also lead to a reward for your help. Qui Tam laws are designed to permit people to bring lawsuits on behalf of the U.S. Government.

ONE OF THE FEDERAL BUILDINGS IN SOUTH FLORIDA

 

Medicare fraud revolves around people telling, keeping, and perpetuating lies, on paper, for government reporting and billing purposes.

 

Healthcare fraud in the United States is rampant, because of third party billing, including Medicare, Medicaid, or private insurance carrier. A medical bill to be paid by an insurance company creates an opportunity for fraud, because the insurance company was not the actual recipient of the services that it is paying for. It is not possible for the insurance company to verify with certainty, actual services performed, or the medical necessity of such services, without a detailed review of patient files and other records. This is rarely done. Healthcare billing is honor system based, replete with checks and balances that are largely under-enforced, due to the enormity of the healthcare system.

 

Are you being prevented by a supervisor from helping patients to the best of your abilities, due to financial, or other concerns, unrelated to healthcare. Are you working in an office more concerned about profit margin than quality healthcare? Are you being reprimanded for trying to do your job competently and honestly?

 

HHS Logo on USFraudCases.comYou may have information about a medicare or healthcare insurance fraud being committed at your office. There are many instances where fraudulent healthcare practices first comes to light as a new employee becomes more knowledgeable about healthcare laws, and more familiar with proper medical procedures, and billing practices associated with their job. Do believe that something just isn't right about the healthcare practices at your office? Can you verbalize your concerns? Do you suspect that a fraud is being perpetrated? Are you willing to investigate your suspicions further? Can you corroborate your suspicions? Do you have papers evidencing the various types of frauds perpetrated?

 

Are healthcare regulations being complied with at your office? Are your office's healthcare practices and procedures different than those required by healthcare regulations? Do you know that your office could not pass a surprise healthcare audit? Are two sets of patient records being maintained in separate locations? Do your office's patient files jive with billing records submitted to the government? Were all medical procedures performed? Were these procedures medically necessary? Were changes made by the billing clerk without doctor authorization? Are claim forms submitted reflecting procedures codes for actual services provided, or with codes to maximize billing? Are procedures split for billing purposes? Are procedures double billed? Are procedure codes added for billing purposes only? Are costs reported correctly? Are there patterns of consistent deficiencies between patient files and billing records for medical services provided?

 

A Medicare / health-care fraud case may surface from information given by a disgruntled employee in an employment action. For instance, a healthcare provider may coerce an employee to do some act that the employee knows is unethical, wrong, fraudulent, or criminal, related to Medicare or Medicaid billing, reporting, or cost accounting. Oftentimes when the employee refuses to comply, they are labeled trouble-makers, become persona non grata in the office, are reprimanded, and are ultimately fired. There have been instances where employees were reprimanded and fired by an employer, for allegedly engaging in the identical conduct that the employees actually refused to participate in.

 

 

 

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ABOUT JOE PAPPACODA

Joseph J. Pappacoda
ATTORNEY JOSEPH J. PAPPACODA

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