Hospital and Medicare Fraud

Hospitals make up a large part of the billion dollar healthcare industry in the United States. The government helps fund hospitals through Medicare and other reimbursement programs in order for hospitals to provide much needed healthcare to the community. However, hospital and Medicare fraud account for a great deal of government waste.

The federal Health Care Financing Administration oversees Medicare and it estimates that the government loses close to $30 billion a years from fraudulent practices in hospitals and doctors’ offices. Hospitals and doctors frequently overbill Medicare and the federal government for the services provided. Due to the large number of Medicare claims, the government pays the claims and then checks for accounting irregularities. In most cases, it is years before the government realizes that the billing is incorrect.

The False Claims Act allows individuals to alert the government about fraud. A Qui Tam claim can be brought on behalf of the government by private citizens. If the lawsuit is successful, the individual can get a percentage of the money the government recovers from the healthcare entity that perpetrated the fraud.

Florida Hospital and Medicare Fraud Attorneys

Lisa Levine and Mark Glassman are familiar with Qui Tam claims in the healthcare industry. Both of them are dedicated personal injury attorneys that are dedicated to representing their clients. With a healthcare industry Qui Tam claim, the victim is the United States government. As a vigilant citizen, you are doing your duty reporting fraud against the government. The lawyers at Levine & Glassman can guide you through the process of filing Qui Tam claims. Contact Levine & Glassman today for a free consultation on your potential Qui Tam case.

Hospital and Medicare Fraud Information Center

• What is the definition of fraud and abuse?
• What are some examples of Medicare fraud?
• Who engages in Medicare fraud?
• How do you report Medicare fraud?
• Ways to prevent Medicare Fraud

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What is the definition of fraud and abuse?

In the healthcare industry for Qui Tam purposes, fraud happens when someone intentionally falsifies information or deceives Medicare. Abuse means that a doctor or supplier does not follow good medical practices which results in waste. Waste means that the doctors and suppliers caused unnecessary costs to Medicare, received improper payment from Medicare or provided services that are not medically necessary. There is a distinction between quality of care and abuse of resources. If you have a quality of care concern, then that could be a possible medical malpractice matter.

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What are some examples of Medicare fraud?

There is a wide variety of Medicare frauds and scams. All of the frauds involve getting false reimbursements from Medicare. The hospitals can practice a large scale fraud by overbilling Medicare for equipment or services. There can be small scale Medicare fraud in doctors’ offices where doctors falsify information and bill Medicare for equipment and services that the patient never used. Some common examples of Medicare fraud include:

• A healthcare provider bills Medicare for services not received.
• A company uses false information to mislead an individual into joining a Medicare plan.
• A supplier bills Medicare for equipment an individual never received.
• A healthcare agency bills Medicare for home medical equipment after it has been returned to the government.
• A company bills Medicare for a drug plan that has not been approved by Medicare.
• A company uses another person’s Medicare card to get medical care or equipment.

Almost every Medicare fraud will involve incorrect billing. Sometimes unqualified people steal Medicare information in order to receive services. Other times, it is a well orchestrated fraud for the purpose of getting “free money” from the government. No matter what the reason, it is illegal to defraud both state and federal government agencies. If you have information about Medicare fraud, do not be afraid to step forward. The False Claims Act contains protections for whistleblowers in order to encourage people to report healthcare fraud and abuse. If you hire Florida Qui Tam lawyers, then they can help you navigate the process.

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Who engages in Medicare fraud?

Anyone can engage in Medicare fraud from big hospitals to individuals. Below is a brief list of companies that are accused of Medicare fraud:

• Hospitals
• Hospice Centers
• Nursing Homes
• Dialysis Clinics
• Ambulance Services
• Doctor’s Office
• Pharmacies
• Individuals

Usually healthcare entities that deal with elderly patients have the opportunity to commit Medicare fraud. Of course there are several reputable healthcare agencies and entities that do not knowingly engage in fraud. However, even if someone is accidently filling out the wrong billing code, there could be a viable Qui Tam case unless the healthcare agency takes the proper steps to notify Medicare of the mistake.

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How do you report fraud?

If you are an individual currently residing in Florida, and you suspect a hospital or doctor of committing Medicare fraud, you can report your suspicions to the Office of Inspector General (OIG) Fraud Hotline at 1-800-447-8477.

When you contact the OIG, provide the office with who, what, when, and how the fraud took place. Also tell them who else has knowledge of the possible violation. Your identity will be protected to the maximum extent of the law. You can make an anonymous tip, but it might hinder the investigation of the fraud. Also, you might not be able to receive compensation if you remain anonymous.

If you are employed for the healthcare entity that is committing the fraud, then it is possible to bring a Qui Tam action. You will have to contact a Florida Qui Tam lawyer for information on how to proceed with a Qui Tam lawsuit.

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Ways to prevent Medicare Fraud

If you are working for a healthcare entity, it is important to make sure you and the staff are familiar with the proper Medicare billing codes. The billing codes can get very complicated, and it is easy to make a mistake. Also some services are billed at a higher rate than others. Resist the temptation to overbill in order to increase revenue.

For individuals with Medicare eligibility, follow these tips to help prevent fraud:

• Never give your Medicare number to anyone except a Medicare provider.
• Don’t allow anyone, except your medical providers, to review your medical records or recommended services.
• Don’t accept medical supplies from salesmen.
• Be cautious if you are offered free testing or screening in exchange for your Medicare number.
• Avoid healthcare providers who tell you that the items or services are not usually covered by Medicare, but they know how to bill Medicare so it will be paid.
• Keep a record of your appointments and tests in case someone is using your information to make fraudulent medical expenses to get unauthorized reimbursements from Medicare.

Both employees and patients need to be vigilant in terms of trying to prevent Medicare fraud. Make sure that you are not a willing participant in Medicare fraud because if you are a participant, then you are banned from receiving compensation.

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Levine & Glassman, P.A. – Florida Qui Tam Lawyers

The attorneys at Levine & Glassman have extensive experience at evaluating and pursuing medical malpractice and fraud claims in Fort Lauderdale and the surrounding areas of Broward, Miami-Dade, and Palm Beach counties. Contact our firm at (954) 332-6100 or using out online contact form and one of our attorneys will evaluate your potential hospital and Medicare fraud case, explain the process of filing such a claim, and answer any other questions you may have. Once you have all of the information about filing a Qui Tam case, and you fully understand the benefits and consequences, we can make a decision together on whether to proceed with your case.