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.
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.
HEALTH CARE FRAUD CASE NETS RECOVERY
OF $1.7 BILLION
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.
