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Hospital and healthcare fraud costs American taxpayers nearly $100 Billion each year. Healthcare fraud can be committed by any medical service provider including physicians, dentists, home health care agencies, or residential care facilities. Healthcare fraud most often involves government health care programs such as Medicare, Medicaid, or Tricare.
One of the ways to fight health care fraud is for a whistleblower to come forward and expose it. At Rosenblat Law, we represent whistleblowers who want to report fraud committed against a government health care program. We have decades of experience helping whistleblowers report instances of fraud across all industries and in helping these whistleblowers collect their statutory award. We will use our extensive knowledge and experience to protect your rights in these cases.
Hospital and healthcare fraud typically involves the filing of fraudulent health care claims. There are many different kinds of healthcare fraud but they all involve a false claim being submitted to the government. Healthcare fraud can be difficult to detect because the fraudulent charges are often hidden behind complicated medical terminology. That is one of the reasons why whistleblowers are often company insiders who can decipher the fraudulent billing practices.
Health care claims use unique billing codes that can show the price of the procedure, the procedure, equipment, or diagnosis that was used. When a healthcare worker submits a claim with a code for a more expensive procedure than what was performed in order to increase their reimbursement, it is called upcoding. An example of upcoding is when a healthcare provider submits a claim for a comprehensive evaluation when only a problem-focused evaluation was performed. Upcoding is one of the more common kinds of fraud because it is so easy for the provider to simply submitted a code with a higher reimbursement rate.
This is another common method of fraud and can occur in many different industries. This often comes in the form of a fraudulent diagnosis for a more expensive service. Overbilling can also happen when doctors charge for services not provided.
There are far too many cases of the fraudulent practice of ordering unnecessary medical procedures. These procedures are not medically reasonable or necessary. The procedures will then be billed to government health care programs or private health insurance companies.
This is when an entity offers financial incentives for the referral of Medicaid or Medicare patients.
Fortunately, the whistleblower statute creates an avenue for reporting healthcare fraud. The False Claims Act allows people to file a claim against a hospital or healthcare provider that submitted false claims to Medicare, Medicaid, or any other government health care program.
If the case is successful, the whistleblower can collect a percentage of the recovered funds as an award. Whistleblowers are also protected from retaliatory behavior like termination, harassment, or demotion.
Health care fraud is a practice that often causes unnecessary harm to patients and always causes harm to American taxpayers.
At Rosenblat Law, we can help you report health care fraud in Chicago, or nationwide, and help you recover the award that you deserve.