Common Types of Health Care Fraud
The False Claims Act is, quite simply, the most powerful tool that we have to deter and redress fraud. Vigorous enforcement of the Act allows us to protect not only taxpayer dollars, but also the integrity of important government
programs on which so many Americans rely.
Tony West, Acting Associate Attorney General.
programs on which so many Americans rely.
Tony West, Acting Associate Attorney General.
Help Fight Medicare Fraud. Contact Seattle Whistleblower Attorneys Today.
Health care fraud cheats taxpayers out of billions of dollars every year.
Who Commits Health Care Fraud?
Health care fraud schemes are rapidly changing and becoming more sophisticated. Unscrupulous persons and companies are found in every health care profession and industry, and fraudulent schemes targeting health care patients, providers, and plans occur in every part of the country and involve a wide array of medical services and products.
This is why whistleblowers are needed.
Fraud has been perpetrated by individual physicians and large publicly traded companies, medical equipment dealers, contract carriers for Medicare and Medicaid, laboratories, hospitals, nursing homes, and home health care agencies. Individual scam artists who provide no health care at all prey upon the nation's health care programs, as well. Fraudulent schemes put billions of dollars in the pockets of individuals and providers who cheat the system, while we struggle to pay for lifesaving drugs to fight AIDS and provide more frequent screening to detect and prevent cancer as well as other life-threatening illnesses.
How Do Perpetrators Commit Health Care Fraud?
Health care fraud schemes are diverse and vary in complexity, with unscrupulous providers targeting both public and private health insurance plans. Common health care fraud schemes include:
Where Does Health Care Fraud Take Place?
Health care fraud schemes have been investigated and prosecuted in every part of the country, in urban and rural areas, and in rich and poor areas. New arenas for fraud are being seen in home health care and hospice services, which are now eligible for reimbursement under federal programs.
What Are the Consequences of Health Care Fraud?
Health care fraud exacts a price from everyone and costs tax payers billions of dollars each year. For instance, two physician practice groups affiliated with the University of Washington paid $35 million to the federal government and the state of Washington to settle a Qui Tam whistleblower lawsuit alleging that the physician groups routinely overbilled Medicare and Medicaid for years. In Tennessee, clinics treated and discharged patients undergoing alcohol and drug rehabilitation without any physician involvement. In Georgia, one scheme involved enrolling impoverished children in after school programs, that were then portrayed as psychotherapy in billings to the state and Federal Government. In Minnesota, a university had been selling a non-FDA approved drug.
Who Commits Health Care Fraud?
Health care fraud schemes are rapidly changing and becoming more sophisticated. Unscrupulous persons and companies are found in every health care profession and industry, and fraudulent schemes targeting health care patients, providers, and plans occur in every part of the country and involve a wide array of medical services and products.
This is why whistleblowers are needed.
Fraud has been perpetrated by individual physicians and large publicly traded companies, medical equipment dealers, contract carriers for Medicare and Medicaid, laboratories, hospitals, nursing homes, and home health care agencies. Individual scam artists who provide no health care at all prey upon the nation's health care programs, as well. Fraudulent schemes put billions of dollars in the pockets of individuals and providers who cheat the system, while we struggle to pay for lifesaving drugs to fight AIDS and provide more frequent screening to detect and prevent cancer as well as other life-threatening illnesses.
How Do Perpetrators Commit Health Care Fraud?
Health care fraud schemes are diverse and vary in complexity, with unscrupulous providers targeting both public and private health insurance plans. Common health care fraud schemes include:
- Billing for services not rendered;
- Billing for services not medically necessary;
- Double billing for services provided;
- Upcoding - billing for a more highly reimbursed service or product than the one provided, or using and billing for a product for a medical condition for which it is not approved;
- Unbundling - billing separately for groups of laboratory tests performed together in order to get a higher reimbursement;
- Fraudulent cost reporting by institutional providers;
- Kickbacks in return for referring patients or influencing the provision of health care are other common schemes. The anti-kickback statute prohibits the payment of kickbacks for the purpose of inducing the referral of services, which are paid for by federal health care programs. Kickbacks corrupt the decision making of medical providers, placing profit above patient welfare. They can lead to grossly inappropriate medical care, including unnecessary hospitalization, surgery, tests, and use of equipment;
- Other types of schemes include providing services by untrained personnel, failing to supervise unlicensed personnel, distributing unapproved devices or drugs, and creating phony health insurance companies or employee benefit plans.
Where Does Health Care Fraud Take Place?
Health care fraud schemes have been investigated and prosecuted in every part of the country, in urban and rural areas, and in rich and poor areas. New arenas for fraud are being seen in home health care and hospice services, which are now eligible for reimbursement under federal programs.
What Are the Consequences of Health Care Fraud?
Health care fraud exacts a price from everyone and costs tax payers billions of dollars each year. For instance, two physician practice groups affiliated with the University of Washington paid $35 million to the federal government and the state of Washington to settle a Qui Tam whistleblower lawsuit alleging that the physician groups routinely overbilled Medicare and Medicaid for years. In Tennessee, clinics treated and discharged patients undergoing alcohol and drug rehabilitation without any physician involvement. In Georgia, one scheme involved enrolling impoverished children in after school programs, that were then portrayed as psychotherapy in billings to the state and Federal Government. In Minnesota, a university had been selling a non-FDA approved drug.
Contact Seattle Whistleblower Attorneys Today
Whistleblower cases can be stressful and complicated, but working with an experienced attorney can make the process much faster and easier. For assistance with your whistleblower case, contact Seattle Whistleblower Attorneys.
Seattle Whistleblower Attorneys, Daniel D. DeLue and Mark Walters, Walters Law Firm PLLC, are experienced whistleblower attorneys and have created a strategic alliance between their law firms to jointly represent whistleblowers in the state of Washington.