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How Whistleblowers Fight Healthcare Fraud

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Healthcare fraud is a serious problem that costs the United States billions of dollars each year. The False Claims Act (FCA) is a federal law that allows private citizens to file confidential lawsuits on behalf of the government against companies or individuals who have defrauded the government's healthcare programs.

Whistleblowers are the first line of defense against healthcare fraud. They can be anyone - from doctors and nurses to administrators and billing staff. Whistleblowers help expose wrongdoing and protect patients and taxpayers from the consequences of fraud.

If you have knowledge of healthcare fraud, you may be able to confidentially file a qui tam lawsuit under the FCA. A qui tam lawsuit is a type of lawsuit that is filed by a private citizen on behalf of the government. If the lawsuit results in a recovery, the whistleblower receives a share of the of the proceeds as ranging from 15-30%. If you have knowledge of healthcare fraud, you should contact an experienced whistleblower attorney to discuss your options. An attorney can help you determine whether you have a valid qui tam claim and can represent you in a qui tam lawsuit.

Here are some examples of healthcare fraud:

  • Billing for services that were not medically necessary
  • Upcoding, which is billing for a more expensive or higher-level service than was actually provided. This may involve billing for a higher level of care, using incorrect diagnosis codes, or misrepresenting the complexity of a procedure
  • Unbundling, which is billing for multiple services when only one service was actually provided
  • Double billing, which is billing for the same service twice
  • Ghost billing, which is billing for services that were never provided
  • Kickbacks, which are payments made to induce referrals for medical services covered by Medicare or Medicaid
  • Doctor-swapping, which is billing under the credentials of one doctor for services performed by another who did not have credentials
  • Prescription drug fraud, such as overprescribing medications for financial incentives, paying or accepting kickbacks from drug companies to prescribe medications, or prescribing brand name drugs when generics are available 

Healthcare fraud can have a devastating impact on patients, taxpayers, and the healthcare system as a whole. Patients may be denied necessary care, taxpayers may be forced to pay for services that were not provided, and the healthcare system may be forced to raise prices to cover the costs of fraud. If you are an insider with knowledge of healthcare fraud, we can help you.