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Confidentiality & Protection
Private citizens play a critical role in reporting healthcare fraud. Under the qui tam provisions of the FCU, private citizens may be entitled to receive a percentage of the qui tam recovery. If you are aware of fraud within the healthcare industry, the law protects you as a whistleblower. We invite you to begin by scheduling a free review of your case today with our experienced Healthcare Fraud Lawyers. Contact us online or call us at 800-372-8304 to get started. Your interaction with our Healthcare Fraud Attorneys is confidential.
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Whistleblower Rewards
For more than 25 years, the Whistleblower Firm of Nolan Auerbach & White has contributed to the recovery of stolen taxpayer dollars due to Healthcare Fraud. Our past clients are heroes, having contributed to the recovery of over $2 billion to the government fisc since the FCA was amended in 1986. Our team of Healthcare Fraud Lawyers endeavor to provide our clients with every tool available in partnering with attorneys, investigators, Government attorneys, and Agencies to expose health care fraud.
Our whistleblower Healthcare Fraud Attorneys have represented clients in obtaining whistleblower awards recovered from companies that engage in fraudulent activities against the federal government. Whistleblower rewards vary from 15-30 percent of the amount collected.
Report These Types of Healthcare Fraud
Healthcare Fraud can be found in all segments of the healthcare industry and in every geographical area of the country. The three largest healthcare programs that the federal government funds are the Medicare Program, the Medicaid Program, and the TRICARE Program. Our whistleblower law firm can help when you’re ready to expose Healthcare Fraud and other violations of the FCA.
When to Report Medicare Fraud
Medicare is a system of healthcare cost reimbursement established by federal statutes, and regulations issued by the US Department of Health and Human Services(HHS). Medicare helps pay for healthcare expenses for the disabled and individuals 65 years of age or older. Our team of Medicare Fraud lawyers are familiar with the many vulnerabilities of this system and are fully qualified to represent you to report Medicare Fraud and other violations of the FCA.
Medicare Part A Fraud
Part A payments are made to institutional providers such as hospitals, skilled nursing facilities, home health agencies, etc., under the Prospective Payment System (PPS).
Part A False Claims Act violations often include:
- Diagnosis-related group (DRG) and other PPS upcoding
- Lack of medical necessity
- One-day stay violations
- Kickbacks
Medicare Part B Fraud
Part B services provided by physicians, suppliers, and other healthcare providers are generally paid on the basis of a Medicare fee schedule. Under Part B, the Medicare beneficiary is responsible for any applicable deductible or coinsurance requirements. When services are covered under Part B, Medicare will use one of the two following methods of payment: (1) payment to the patient; (2) payment to the doctor (or supplier or other healthcare entity). This second method is known as the “assignment” method.
Part B violations of the FCU may include:
- Billing for any services not rendered or products not ordered
- Misrepresenting services rendered or product provided (e.g., upcoding, unbundling)
- Billing for medically unnecessary services
- Falsifying records to meet or continue to meet the conditions of payment or participation
- Increasing units of service that are subject to a payment rate
- Laboratory unbundling or upcoding
Contact our Healthcare Fraud attorneys today to report Medicare fraud.
Medicare Part C Fraud
Medicare beneficiaries may select a managed care plan certified under Medicare. Payments that Medicare makes to the managed care plan replace the amounts Medicare otherwise would have paid under traditional Medicare.
Part C violations of the FCU may include:
- Inflated general and administrative costs
- Intentional failure to pay providers or provide reasonable and necessary services to beneficiaries
- Managed Care Organization (MCO) and physician relationships that are driven by cost-containment at the expense of patient care
Medicare Part D Fraud
In the Medicare Part D plan, all Medicare beneficiaries get access to the Medicare drug benefit via private plans approved by the Centers for Medicare & Medicaid Service (CMS). The drug benefit is offered through Medicare Advantage prescription drug (MA-PD) plans and stand-alone Prescription Drug Plans (PDPs). Part D is a market model that transfers risk to private plan sponsors, which then play the role of insurers for Part D benefits.
To discuss your options, contact a Healthcare Fraud Lawyer today to learn more.
Part D violations of the FCU may include:
- Submitting claims or other false documentation for non-covered drugs as covered
- Failure to apply “maximum allowable cost” pricing to drugs
- Submitting claims or other false documentation for drugs not provided
- Submitting claims or other false documentation for brand name drugs when generics are dispensed
- submitting claims or other false documentation to multiple payors for the same prescription (except as required for coordination of benefit transactions)
- Off-label marketing by pharmaceutical manufacturers
- Submitting claims or other false documentation concerning drugs containing other false representations to CMS, including but not limited to: false physician identifiers and brand-name drugs when generics were dispensed.
- Unlawful kickbacks to either the dispensing provider or the Part D Plan, or the submission of false information in connection with obligations under the Discount Program Agreement.
For more on these types of violations, visit our Part D Medicare Fraud attorney page.
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Common Medicaid Fraud
Medicaid is a joint federal-state entitlement program that provides healthcare for low-income people. Each state’s Medicaid program is administered through a specific state entity, and the program itself is not always called “Medicaid” per se. For instance, in California, the program is called “Medi-Cal.”
With traditional Medicaid, the states directly reimburse healthcare providers for services rendered. The state obtains the federal share of the payment from accounts that draw on funds of the United States Treasury. Medicaid is the second-largest healthcare program in the federal budget and the second-largest state spending item, surpassed only by elementary and secondary education. Most states also provide Managed Care Plans in lieu of traditional Medicaid, which Plans have substantially increased in Medicaid enrollment in recent years.
Medicaid Fraud can take many forms, including:
- Billing for any services not rendered or products not delivered
- Billing for services or supplies not ordered
- Misrepresenting services rendered or product provided e.g., Upcoding, inappropriate coding
- Billing for medically unnecessary services – this includes furnishing services in excess of the patient’s needs and misrepresenting the diagnosis to justify the services or products
- Duplicate billing
- Falsifying records to meet or continue to meet the Conditions of Payment or Conditions of Participation
- Increasing units of service
- Billing procedures over a period of days when all treatment occurred during one visit i.e., split billing
- Laboratory unbundling – in this scenario, tests and other services that are automatically performed as a panel, group or set, should be billed as a single service. When a provider breaks these services out of the bundled group and bills them individually, the provider is deemed to be “unbundling.”
- Unlawfully providing kickbacks to healthcare providers in exchange for referrals or prescriptions.
If you’ve become aware of any of these fraudulent activities, we encourage you to contact the experienced team of Medicaid Fraud Lawyers at Nolan, Auerbach & White. Our Whistleblower Healthcare Fraud Law Firm is ready to hear your important story.
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Common TRICARE Fraud
TRICARE (f/k/a CHAMPUS) is the component agency of the U.S. Department of Defense that administers and supervises the healthcare program for certain military personnel and their dependents. TRICARE contracts with a fiscal intermediary that receives, adjudicates, processes, and pays healthcare claims submitted to it by TRICARE beneficiaries or providers.
Fraud against the TRICARE program can take many forms, including:
- Billing for services not rendered or products not delivered
- Billing for services or supplies not ordered
- Misrepresenting services rendered or product provided (e.g., upcoding, inappropriate coding)
- Billing for medically unnecessary services
- Duplicate billing
- Falsifying records to meet or continue to meet the Conditions of Payment or Conditions of Participation
- Increasing units of service
- Billing procedures over a period of days when all treatment occurred during one visit i.e. split billing
- Laboratory unbundling – in this scenario, tests and other services that are automatically performed as a panel, group, or set, should be billed as a single service. When a provider breaks these services out of the bundled group and bills them individually, the provider is deemed to be “unbundling”
- Unlawfully providing kickbacks to healthcare providers in exchange for referrals or prescriptions
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We Handle These Common Types of Healthcare Fraud
Our Healthcare Fraud qui tam attorneys have the knowledge and experience to discuss in-depth areas of Healthcare Fraud. Other common types of fraudulent activity include:
Expose Healthcare Fraud through the qui tam lawsuit process, and join the many whistleblower heroes who have stepped forward and exposed violations of the law, taking a stand for justice and taxpayers in the healthcare industry. It could mean that you share a percentage of the funds recovered from fraudulent activity by working with one of our experienced Healthcare Fraud lawyers.
Get started by filling out our online form, or give our experienced team of healthcare fraud attorneys a call today at 800.372.8304.
Learn more about our experienced Healthcare Fraud Lawyers on our Team Page or click on these Healthcare Fraud Attorneys below:
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Frequently Asked Questions About Healthcare Fraud Lawsuits
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What is the False Claims Act in Healthcare?
Under The FCU, first enacted under President Abraham Lincoln, the law provides for treble damages against anyone who, inter alia, knowingly submits a material false record (including fraudulent documents) or false claim to the United States. The FCU also provides for private citizens to file qui tam lawsuits, which allows private citizens to file sealed lawsuits in federal court that seek recovery of government money obtained in violation of the FCU. To learn more, contact our Healthcare Fraud Law Firm.
✅ Who Can Sue Under the False Claims Act?
Private individuals acting as whistleblowers can sue companies that have defrauded the U.S. government. The law also provides for whistleblower protection against retaliation, and for an award based upon a percentage of the amount recovered.
✅ What Is The Most Common Form of Healthcare Fraud and Abuse?
According to the United States Government Accountability Office (GAO), most Healthcare Fraud relates to “fraudulent billing, such as billing for services that were not provided (about 43 percent of cases) and billing for services that were not medically necessary (about 25 percent).” A whistleblower attorney can help individuals file a qui tam lawsuit against companies engaged in Healthcare Fraud that violates the FCA.
