Whistleblower Healthcare Fraud Lawyers

Contact the Healthcare Whistleblower Firm of Nolan, Auerbach & White to get started on a free and confidential review of your important case today.

Call our False Claims Act attorneys at 800-372-8304.
 

Jump To Contents 

• Whistleblower Protections & Reward Incentives
• Report Medicare Fraud (Part A, B, C, D)
• Report Medicaid Fraud
• Report TRICARE Fraud
• Other Common Healthcare Fraud
• Contact Us
• FAQs About Medical Fraud Lawsuits

Confidentiality & Protection

Private individuals play a critical role in reporting healthcare fraud, bringing justice, restoring much-needed medical funds to their assigned programs. Under the qui tam provisions of the False Claims Act, it is possible to collect a percentage of what has been recovered as an award for this critical service. Our whistleblower attorneys abide by these qui tam provisions and encourage private individuals who are aware of Healthcare Fraud to bring such information forward.

If you are aware of fraud within the healthcare industry, the law protects you as a whistleblower. We invite you to begin this important duty and service by scheduling a free review of your case today. Contact us online or call us at 800-372-8304 to get started. Your interaction with our qui tam attorneys is confidential.

Learn More: Whistleblower Protection

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REPORT HEALTHCARE FRAUD 

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Whistleblower Reward Incentives

For more than 25 years, the Whistleblower Firm of Nolan Auerbach & White has contributed to the recovery of fraudulent healthcare funds. Our past clients are heroes, having contributed to the recovery of over 2 billion to the government fisc. We endeavor to provide our heroes with every tool available in partnering with attorneys, investigators, Government attorneys, and Agencies to expose healthcare 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. Each of these entities may involve fraudulent activity that should be reported by protected whistleblowers. Our whistleblower law firm can help when you’re ready to report healthcare fraud. 

When to Report Medicare Fraud

Medicare is a system of healthcare cost reimbursement established by federal statutes and regulations issued by HHS. Medicare helps pay for certain healthcare expenses for individuals 65 years of age or older. Our team of Medicare Fraud lawyers are familiar with the many vulnerabilities of this system to fraudulent behavior and are fully qualified to represent you to report unethical medical billing practices and other instances of Medicare fraud.

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 groups (DRG) upcoding
• Lack of medical necessity
• One-day stay violations

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 False Claims Act violations may include:

• Billing for 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 Medical billing 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 False Claims Act violations 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. 

Part D False Claims Act violations 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 its obligation under the Discount Program Agreement.

For more on these types of violations, visit our Part D Medicare Fraud attorney page.  

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REPORT MEDICARE FRAUD 

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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 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 Firm is ready to hear your important story. 

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REPORT MEDICAID FRAUD 

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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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REPORT TRICARE FRAUD 

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Report These Additional 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 we encounter and encourage individuals to report include:

• Hospital Fraud
• Pharmaceutical Fraud
• Medical Equipment Fraud 
• Stark Statute Violations – prohibiting physicians from making referrals of patients to entities in which physicians have business relationships
• Anti-Kickback Statute Violations – prohibiting payment of kickbacks in exchange for referrals.

• Home Healthcare Fraud – fraud schemes under the Home Healthcare Reimbursement program
• Ambulance Fraud – applicable to ambulance providers
• SNF Fraud – healthcare fraud common to skilled nursing facilities
• LTACH Fraud– healthcare fraud common to long term acute care hospitals

Contact a Healthcare Fraud Law Firm That Empowers Whistleblowers

It’s time to report the Healthcare Fraud you’ve become aware of. 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. 

Get started by filling out our online form for potential clients, or give our experienced team of healthcare fraud attorneys a call today at  800.372.8304.

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REPORT HEALTHCARE FRAUD 

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Frequently Asked Questions About Healthcare Fraud Lawsuits