Fraud on the healthcare system costs taxpayers millions of dollars every year. The federal government is the country’s largest payer of healthcare costs, channeling billions of dollars to healthcare providers each year through Medicare, Medicaid, the Federal Employees Health Benefit Plan, and TRICARE (the health insurance program for the military and their families).
The government estimates that as much at 10% of these payments are for improper charges. If you have knowledge of healthcare fraud, it’s crucial that you speak up. At Kreindler & Associates, we understand that the prospect of coming forward as a whistleblower is a daunting one, and we’re here to protect your rights when you find the courage to speak up.
What Is Healthcare Fraud?
Healthcare fraud can be perpetrated by anyone in the healthcare field, including diagnostic companies, laboratories, hospitals, doctors, nursing homes, and medical equipment providers. More often than not, it’s honest professionals and employees in these fields who have knowledge of ongoing fraud and play the crucial role of whistleblowers.
There seems to be no end to the ways these unscrupulous individuals and companies find to bilk government-funded health insurance programs and steal tax dollars from honest Americans. Some of the most common forms of healthcare fraud include:
- Upcoding or unbundling services in order to charge more
- Billing for medical services or products not provided
- Providing and billing for medically unnecessary services or products
- Billing for brand name drugs when generics are administered
- Paying kickbacks or bribes for patient referrals or to generate product sales
- Misrepresenting service locations, service dates, or providers
- Filing false hospital cost reports
Misuse of medical research grants
Off-label marketing or inflated pricing of prescription drugs
This list is by no means exhaustive. Healthcare fraud schemes are often complex and involve more than one form of impropriety. That’s why whistleblowers who are willing to come forward are so important.
Those who find the courage to speak up against unscrupulous healthcare providers will not see their efforts go unrewarded. Under the False Claims Act, a whistleblower who provides evidence that leads to government recovery for fraud stands to receive an award of up to 30% of the amounts recovered, depending on the circumstances of the case. Whistleblowers are also treated with confidentiality and protected from retaliation by their employers in response for speaking up.