Health Care Fraud
Fraudulent Billing Practices & Other Forms of Deception
No other area has created larger victories for whistleblowers than pharmaceutical and healthcare fraud. The federal government provides billions of dollars to hospitals, physicians, and other medical facilities in the form of Medicare and Medicaid subsidies, and unfortunately the system is prone to fraudulent billing practices and other forms of deception.
If you have witnessed a company or physician engaging in any of the practices below, contact Riddle & Brantley, LLP by calling (800)525-7111. You may be able to file a qui tam claim under the False Claims Act.
Off-Label Use of Pharmaceuticals
The Food and Drug Administration (FDA) stringently regulates the medications provided to Americans as well as their intended uses. When a pharmaceutical company markets a drug or medical device for a purpose other than that for which the medication was tested and approved, the company is violating the False Claims Act. This off-label use can also be promoted through the use of kickbacks to physicians or medical facilities.
Kickbacks to Doctors or Facilities
Pharmaceutical companies which offer incentives to physicians or hospitals for using their product over others, or using their product when it is not necessary, are guilty of providing illegal kickbacks. These incentives can be financial, such as monetary bonuses for every device used or prescription written, or they can be much more subtle, such as all-expenses paid trips to conferences in exotic locales.
Billing Fraud—Upcoding, Unbundling, and Phantom Patients
Doctors and hospitals bill the Medicare and Medicaid systems by entering codes that correspond to a patient’s treatment and medication. The bill to the federal government is often inflated through fraudulent billing practices which result in increased payments to the biller.
Upcoding or unbundling are common types of fraud. A bill is upcoded when a provider bills for a more expensive version of the treatment, rather than what was actually used. Unbundling occurs when treatments which normally occur and are billed together are separated to increase the total price.
In addition to upcoding and unbundling, many facilities have been caught billing for phantom patients which do not exist. Money for these patients goes directly into the pockets of the health care provider. In the same way, providers may also bill for services which the patient did not need, and were never actually performed.
In order to submit a claim for fraudulent Medicare or Medicaid services, documentation reflecting the veracity of the claim must be submitted. If a claim is upcoded or for a phantom patient, the signatures of physicians may be forged on the necessary forms.
False certifications can also become a problem when lesser-quality equipment is substituted in place of more expensive equipment. Inspection certificates or training certifications may be created in order to sustain the fraud.
Have You Witnessed Fraud?
If you work in the health care industry and have witnessed any of these activities, you may be able to file a qui tam action under the False Claims Act. It can be intimidating to file an action against an employer or former employer, which is why Riddle & Brantley, LLP will walk you through every step of the process.
Our experienced whistleblower action attorneys have a proven track record of success and decades of experience earned by litigating complex claims. We proudly offer complimentary consultations and are ready to discuss the merits of your potential lawsuit.
For a free consultation about your whistleblower claim, fill out our online case evaluation form or call Riddle & Brantley, LLP at 800-525-7111.