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Sunday, January 1, 2012

Expansion of Medicaid Fraud Whistleblower Reward Laws by Medicaid Fraud Whistleblower Lawyer

New whistleblower reward laws are expanding the ability of Medicaid fraud whistleblowers to collect large economic rewards to encourage health care providers to blow the whistle on health care fraud including illegal Medicaid retention of overpayments, Medicaid illegal kickback scams, Medicaid upcoding, Medicaid double billing, Medicaid false coding, Medicaid unbundling, and other fraudulent Medicaid billing practices.  Understanding the new state and federal Medicaid fraud Bounty Reward Action laws and whistleblower protection laws can be helpful for any health care professional that works in a health system that takes Medicaid, Medicare, or other forms of government health care benefits.   

New Medicaid Fraud Bounty Reward Laws and Federal False Claims Act Amendments including Medicaid Retention Overpayment Lawsuit, Medicare Retention of Overpayment Fraud Lawsuit, and Hospital Employee Whistleblower Lawsuit Information

The 2009 Fraud Enforcement and Recovery Act (FERA) and many new state Medicaid fraud whistleblower laws are expanding Medicaid fraud whistleblower recovery laws and other Bounty Reward Actions to increase potential rewards for relators, expand potential liability for Medicaid fraud criminals and violators, and to increase protections to Medicaid fraud whistleblowers.  These new laws are designed to help the Federal government and state governments identify, recoup, and crack down on Medicaid fraud, Medicare fraud, and other forms of health care fraud which is estimated to be over $100 Billion per year. 

With Medicare and Medicaid costs continuing to grow and many government budgets being tight, it is essential that health care providers with knowledge of Medicaid fraud, Medicare fraud, or other health care fraud to step up and expose the health care fraud and systematic Medicaid fraud that is the fasting growing and most lucrative crimes in the United States.    

In developing and strengthening Medicaid fraud whistleblower laws, governments are setting up increased whistleblower protections and economic incentives to encourage health care providers to blow the whistle on traditional qui tam health care fraud causes of action and are expanding the causes of action to include rewards to whistleblowers that expose retention of Medicaid overpayments.  Many of these False Claims Act statutes and Medicaid Fraud statutes have also been expanded to include government contractor false claims, government grantee false claims, and other recipients of government money that submit false claims to obtain this money.

State Medicaid False Claims Act Lawsuit, Medicaid Fraud Whistleblower Reward Lawsuit, State Medicaid False Billing Whistleblower Award Lawsuit, Medicaid Double Billing Fraud Lawsuit, Federal Medicaid Fraud False Billing Lawsuit, Unnecessary Medical Treatment Relator Lawsuit, and Medicaid Fraud Whistleblower Lawsuit Information

Medicaid is a federal/state cost-sharing program that provides health care to people who are unable to pay for such care.  The Medicaid Program is jointly funded by state and federal governments, but is managed by the states.  Medicaid is the largest source of funding for medical and health-related services for people with limited income in the United States and the Medicaid program has been increasing.  The fastest growing aspect of Medicaid is nursing home coverage and this is expected to continue as the Baby Boomer generation begins to reach nursing home age.  

Unlike Medicare, which is solely a federal program, Medicaid is a joint federal-state program. Each state operates its own Medicaid system.  Each state's Medicaid Program must conform to federal guidelines in order for the state to receive matching funds and grants.  For many states Medicaid has become a major budget issue as on average the state's matching costs of the Medicaid program is about 16.8% of state general funds. According to CMS, the Medicaid program provided health care services to more than 46.0 million people in 2001. In 2008, Medicaid provided health coverage and services to approximately 49 million low-income children, pregnant women, elderly persons, and disabled individuals. Federal Medicaid outlays were estimated to be $204 billion in 2008.  Medicaid payments currently assist nearly 60 percent of all nursing home residents and about 37 percent of all childbirths in the United States. The Federal Government pays on average 57 percent of Medicaid expenses.

Medicaid fraud is a violation of federal law and several new state Medicaid fraud laws.  Health care providers that are convicted of Medicaid fraud can be fined, incarcerated, and lose their status as Medicaid providers.  To prevent Medicaid fraud, several states including Texas, California, Florida, Hawaii, Massachusetts, Nevada, Tennessee, Wisconsin, New Jersey, Georgia, Michigan, Illinois, Louisiana, Delaware, Indiana, Minnesota, Montana, New Mexico, Oklahoma, North Carolina, and Virginia have enacted state Medicaid fraud whistleblower recovery laws.  These Medicaid fraud whistleblower laws are based on the Federal False Claims Act and many acts of large scale systematic Medicaid fraud will entail aspects of several different laws.     

There are many types of Medicaid fraud that may be the basis for Medicaid fraud whistleblower recovery lawsuits and other qui tam claims including:
  • billing Medicaid for X-rays, blood tests and other procedures that were never performed
  • falsifying a patient’s diagnosis to justify unnecessary tests;
  • giving a patient a generic drug and billing for the name-brand version of the medication;
  • giving a recipient a motorized scooter and billing for an electric wheelchair, which can cost three times more;
  • billing Medicaid for care not given;
  • billing Medicaid for patients who have died or who are no longer eligible for Medicaid;
  • billing Medicaid for care given to patients who have transferred to another facility;
  • transporting Medicaid patients by ambulance when it is not medically necessary;
  • requiring vendors to “kick back” part of the money they receive for rendering services to Medicaid patients (kickbacks may also include vacations, merchandise, etc.);
  • billing patients for services already paid for by Medicaid;
  • billing Medicaid for phantom patients;
  • double billing Medicaid for services;
  • upcoding services for increased Medicaid payments.
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.

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