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Monday, September 9, 2013

Report Hospital Billing Fraud and Collect Large Financial Rewards: Medical Professionals That Properly Report Hospital Billing Fraud Can Collect Large Financial Rewards By Hospital Billing Fraud Lawyer

Report Hospital Billing Fraud and Collect Large Financial Rewards: Medical Professionals That Properly Report Hospital Billing Fraud Can Collect Large Financial Rewards By Hospital Billing Fraud Lawyer Jason S. Coomer

Hospital billing fraud includes upcoding, false coding, false certifications, double billing, phantom patients, unbundling, and illegal kickbacks.  These forms of billing fraud are costing the government billions of dollars and can be the basis of qui tam whistleblower reward lawsuits that offer large financial rewards to medical professions including hospital administrators and other hospital employees that properly expose significant hospital billing fraud.   

For more information on properly reporting hospital billing fraud and having a potential hospital billing fraud case confidentially reviewed, please feel free to contact Hospital Billing Fraud Lawyer, Jason S. Coomer, via e-mail message or go to the following webpage: Report Hospital Billing Fraud and Whistleblower Reward Lawsuit.  

Being the First to File on a Hospital Billing Fraud Scheme is Essential for Recovery Under the False Claims Act

It is essential to not delay in coming forward with a Hospital Billing Fraud Qui Tam Whistleblower Action as the first whistleblower to file is eligible to be a relator and can make a large recovery for exposing the fraud.  Additionally, when the fraudulent scheme is exposed, the people that kept the fraud secret can sometimes be found liable for criminal activity for not exposing the fraud that was being committed.

Hospital Billing Fraud Whistleblower Lawsuits Include Upcoding Qui Tam Whistleblower Lawsuits and Coding Fraud Whistleblower Lawsuits

Upcoding occurs when a medical service provider intentionally and fraudulently upcodes services to obtain a higher reimbursement than one that is entitled to for the service that was actually provided.  In both the Medicare and Medicaid systems a set of billing codes is used by healthcare providers to bill for services. These codes are known as the Healthcare Common Procedure Coding System (HCPCS). A service provider that intentionally uses a higher paying code to fraudulently reflect that a more expensive procedure or device was involved in the patient’s treatment than actually was used or was necessary.  A pattern of intentional upcoding treatment can result in large profits for the healthcare provider, but also cost taxpayers millions of dollars.

Upcoding fraud is typically hard to catch without the help of persons with inside information because that Healthcare Common Procedure Coding System (HCPCS) codes are billed electronically and can easily slip through the system.  Therefore unless the upcoding is caught through a random audit (approximately 2% of the claims per year are audited), it is up to insiders, informants, heroes, and health care professionals to catch fraudulent upcoding.

Another type of coding fraud is “unbundling”, where bundled related procedures or composite lab tests are run together, but billed separately by the lab or healthcare provider to obtain more compensation.  These types of billing fraud also allow healthcare providers and labs to make higher profits by bilking Medicare, Medicaid, and taxpayers out of millions of dollars.  These unbundling fraud schemes are also hard to detect without someone that is familiar with the codes and billing.

Hospital Billing Fraud and Other Forms of Health Care Fraud Are Costing The United States and U.S. Taxpayers About $100 Billion Each Year

Law enforcement authorities estimate that health-care fraud costs taxpayers about $100 billion each year.  Through Health Care Fraud Qui Tam Lawsuits billions of dollars have been recovered from individuals and organizations that have committed health care fraud on the United States Government and State Governments. 


HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company) and HCA subsidiaries agreed to pay the United States over $1.7 Billion including $631 million in 2003 for civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs. In 2000, HCA subsidiaries pled guilty to substantial criminal conduct and paid more than $840 million in criminal fines, civil restitution and penalties.  HCA will paid an additional $250 million to resolve overpayment claims arising from certain of its cost reporting practices.  In total, the government will have recovered $1.7 billion from HCA.

This Qui Tam settlement resolved fraud allegations against HCA and HCA hospitals in nine False Claims Act qui tam or whistleblower lawsuits pending in federal court in the District of Columbia. Under the federal False Claims Act, private individuals may file suit on behalf of the United States and, if the case is successful, may recover a share of the proceeds for their efforts. Under the HCA settlement, the whistleblowers will receive a combined share of $151,591,500.00.

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