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Sunday, November 4, 2012

Medicare Fraud Whistleblowers: Probate Lawyers and Executors Are Seeing More Medicare Fraud That Can Be The Basis of Medicare Fraud Whistleblower Reward Lawsuits by Medicare Fraud Whistleblower Lawyer Jason S. Coomer

Medicare Fraud Whistleblowers: Probate Lawyers and Executors Are Seeing More Systematic Medicare Fraud By Nursing Homes, Home Health Care Providers, and other Health Care Providers That Can Be The Basis of Medicare Fraud Whistleblower Reward Lawsuits by Medicare Fraud Whistleblower Lawyer Jason S. Coomer

Health care costs in the United States are over $2.3 Trillion each year and are continuing to rise.  Included in these costs are a significant amount of Medicare fraud including nursing home Medicare fraud, home health care fraud, assisted living facility Medicare fraud, and other fraud directed at seniors.  Some estimates suggest that health care fraud including Nursing home Medicare fraud is about 10% of the cost of health care.  These numbers are expected to rise as more people become eligible for Medicare and more people move to nursing homes and assisted living facilities.

Because of the growing number of Medicare eligible recipients, more and more people will pay for their health care including nursing homes, hospice, home health care, physical therapy, pharmacies, and medical equipment through Medicare.  The nursing homes and associated health care providers that accept Medicare payments too often find that it is more profitable to use fraudulent billing practices to increase their income from Medicare.  These nursing homes and elder care providers sometimes begin to use systematic Medicare Fraud including upcoding, manipulation of outlier payments to Medicare, illegal kickbacks, charging for unnecessary services, double billing for services, and falsely certifying goods or services that were not provided are all forms of Medicare fraud that cost United States taxpayers billions of dollars each year. 

These forms of Medicare fraud can often be difficult to detect and often require the family of a senior or the administrator of the person's estate to detect the fraud.  In these situations, it is important to determine if there is significant billing fraud taking place and if it may be systematic.  If this is the case, it can often be beneficial to work with a Medicare fraud whistleblower lawyer to determine the extent of the fraud and help build a whistleblower reward lawsuit that can expose the fraud as well as potentially result in a large financial recovery.
Skilled Nursing Facility (SNF) Medicare Billing, Elder Care Billing, Nursing Home Revenue, and the Prospective Payment System (PPS)

Most nursing home and elder care costs are paid through Medicare, Medicaid, and government programs.  To be able to collect Medicare, Skilled Nursing Facilities have to use the Prospective Payment System and follow government regulations.  Under these regulations, Medicare will pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitation services. To be covered, the person must receive the services from a Medicare certified skilled nursing home after a qualifying hospital stay. A qualifying hospital stay is the amount of time spent in a hospital just prior to entering a nursing home.  Unfortunately, some Skilled Nursing Facilities are violating the qualified hospital stay requirement.

In the Balanced Budget Act of 1997, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare covered skilled nursing facilities SNF stay be included in a bundled prospective payment made through the fiscal intermediary (FI)/A/B Medicare Administrative Contractor (MAC) to the skilled nursing facilities SNF. These bundled services have to be billed by the skilled nursing facility to the FI/A/B MAC in a consolidated bill.  This Consolidated Billing in nursing homes was implemented in 1998 and required all skilled nursing facilities (SNFs) and nursing facilities (NFs) to file consolidated billing for Medicare.

Under Consolidated Billing the facility must submit all Medicare claims for the Part B services and supplies that all its Medicare residents receive, except for certain services specifically excluded. Medicare pays the facility, and the facility then reimburses any external providers or suppliers according to contractual arrangements.

By checking Medicare Summary Notice (MSN), a Medicare recipient, guardian, or estate administrator may discover systematic Medicare fraud that can result in a large Medicare fraud whistleblower recovery for the government and for the persons that report the systematic Medicare fraud.  Medicare fraud whistleblowers that are able 1) to obtain original and specialized information of significant fraud and 2) are the first to file regarding the specific Medicare fraud can save taxpayers millions of dollars and recover a large reward for reporting the fraud. 

For more information on properly reporting a large health care provider that is committing systematic Medicare fraud including double billing, phantom billing, illegal kickbacks, upcoding, bill padding or other types of Medicare Fraud, please feel free to contact Medicare Fraud Whistleblower Lawyer Jason Coomer.

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