Are You Aware of Hospital Fraud?
Contact the Whistleblower Hospital Fraud Lawyers of Nolan, Auerbach & White to get started on a free and confidential review of your important case. Call our Qui Tam attorneys at 800-372-8304.
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Filing a Hospital Fraud Claim – Whistleblowing in Healthcare
If you’ve become aware of fraud in the hospital setting, we can help you deliver justice. Whistleblowing in healthcare means you are bringing to light known abuses and working to restore much-needed funds for patient care. The Hospital Fraud Lawyers at Nolan Auerbach & White are here to guide you through reporting hospital fraud, filing your whistleblower lawsuit, and moving through the complex legal system.
Reward Incentives for Hospital Fraud Whistleblowers
Under the qui tam provisions of the False Claims Act, hospital fraud whistleblowers may be entitled to collect a percentage of what has been recovered as an award for this important service. Whistleblower rewards for Hospital Fraud vary from 15-30 percent of the amount collected.
Our hospital fraud lawyers encourage private individuals aware of fraudulent activity to bring such information forward.
Whistleblower Confidentiality and Protection
If you are aware of fraud within the hospital setting or healthcare industry, the law protects you as a whistleblower. We invite you to submit an overview of your case to our team of hospital fraud lawyers to begin this vital duty and service. Your interaction with our experienced hospital fraud attorneys is confidential. Contact us online or call us at 800-372-8304. to get started.
Learn More: Whistleblower Protection
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How To Report Hospital Billing Fraud & Similar Abuses
Our Hospital Fraud Law Firm is familiar with the many vulnerabilities hospitals have to fraudulent behavior. We are fully qualified to represent you to report unethical medical billing practices and other instances of healthcare fraud.
Some of the most important steps our Hospital Fraud Attorneys recommend for how to report healthcare fraud include:
- Gather documentation – Be sure not to not violate any company policies or procedures. Only download, photocopy, or take any documentation or materials you are entitled to view.
- Write a memo to yourself describing the fraud – Do this as soon as you can. Cases take years and memories become less accurate with time.
- Create a list of documents relevant to the case that are not in your possession
Learn More: Guide to Reporting Hospital Fraud
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Report These Types of Hospital Fraud
Hospital Fraud and other abuses exist in all healthcare industry segments and throughout the country. Our hospital fraud law firm can help when you’re ready to report fraud.
Review some of the most common hospital fraud cases below.
Inpatient services must be medically necessary and constitute an appropriate level of care. Patient admissions must be medically necessary, and implicit within the payment is that patient discharges are not premature.
Upcoding APC diagnosis and the intentional manipulation of code assignments to avoid National Correct Coding Initiative (NCCI) edits are common forms of outpatient Hospital Fraud.
The Outpatient Prospective Payment System (OPPS) rules require hospitals to submit claims for all OPPS services provided at the same hospital, to the same patient, on the same day, unless certain conditions are met. The submission of multiple claims for OPPS services delivered to the same patient on the same day may also violate the False Claims Act.
Cost Report Fraud can include improper reporting of “pass-through” new technology and drugs, misreporting organ acquisition costs, false calculations with regard to graduate medical education (GME) and indirect graduate medical education (IME) costs, and more.
Patient Transfer False Coding Violations
Patient transfers to certain post-acute care settings for certain designated Diagnosis Related Groups (DRGs) must be properly coded so that a hospital will receive a per diem transfer payment, rather than the full DRG payment. Inappropriate patient transfers between a host hospital and a hospital-within-a-hospital may constitute an FCA violation. Other outpatient hospital fraud, for example, can take the form of submitting claims for hospital technical components for services rendered by physicians in clinics and other settings that do not meet the criteria of “provider-based.”
Report These Additional Hospital Violations
Is It Fraud? Hospital and Physician Violations
The Office of Inspector General (OIG), part of the U.S. Department of Health and Human Services, provides Supplemental Compliance Guidance for Hospitals, highlighting some additional recognized areas that have an increased risk of fraud.
These include relationships between hospitals and physicians including referral sources. Financial relationships with referring physicians must fit squarely within statutory or regulatory exceptions to the Stark law. Compliance with Stark laws is mandatory, potentially resulting in significant financial exposure for hospitals that fail to comply.
Medical Director Agreements
Medical Director Agreements can be used inappropriately to pay physicians for referrals. Hospitals may also provide free or reduced cost hospital space, equipment, or personnel for physicians to conduct their private practices, in exchange for referrals. Arrangements that involve “conditioning privileges on a particular number of referrals or requiring the performance of a particular number of procedures often violate the [anti-kickback] statute.”
Exclusive contracts with hospital-based physicians such as radiologists, pathologists, hospitalists, and anesthesiologists may be problematic. While contracts can involve certain reasonable administrative or limited clinical duties directly related to the hospital based professional services (including participation in an on-call rotation) at a reduced cost or no charge, the free services must reasonably reflect the value of the exclusivity conferred on the hospital-based physicians.
OIG remains suspicious of physician-owned joint ventures, noting that ”remuneration from a joint venture [e.g. dividends, profit distribution] might be a disguised payment for past or future referrals to the venture or to one or more of its participants.” When physicians invest in and make referrals to ancillary service providers such as diagnostic labs, medical office buildings, or hospital ownership, the OIG views such arrangements as potential vehicles for impermissible referrals.
Additional Fraud Whistleblowers Are Reporting
Our experienced Hospital Fraud Lawyers are available to discuss in-depth areas of Healthcare Fraud. Other common types of fraudulent activity we encounter and encourage private individuals to report include:
Need to know the strength of your case? Submit your facts confidentially to our experienced Hospital Fraud Law Firm today for a free case evaluation.
CONTACT A HOSPITAL FRAUD LAWYER
When to Report Hospital Fraud
If you’ve become aware of fraudulent activity, we encourage you to contact the experienced team of Healthcare Fraud Lawyers at Nolan, Auerbach & White. Our Whistleblower Firm is ready to hear your important story. Our free case review process helps individuals identify fraudulent medical billing practices and other common violations. Give us a call today, begin your free review, and move forward with confidence.
It’s time to report the Hospital Fraud you’ve become aware of. Join the many whistleblower heroes that have stepped forward to expose violations of the law, taking a stand for justice. Many whistleblowers are eligible to 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 hospital fraud attorneys a call today at 800-372-8304.
FREE FRAUD CASE EVALUATION
Frequently Asked Questions About Hospital Whistleblower Cases
✅ What Is Hospital Fraud?
Hospital fraud typically results in a violation of the False Claims Act. Hospitals may employ a number of schemes that constitute fraudulent activities to include DRG and APC upcoding, paying kickbacks in exchange for referrals and additional abuses. To learn more, click here to contact our team of Hospital Fraud Attorneys.
✅ Do Whistleblowers Get Paid for Exposing Hospital Fraud?
Yes, eligible whistleblowers may receive between 15-30 percent of the amount collected in hospital fraud cases. To learn about eligibility, begin a free review of your important case.
✅ What Is The Most Common Form of Hospital Fraud and Abuse?
The United States Government Accountability Office (GAO) reports that 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 hospital fraud attorney can guide private individuals through the legal process and help accurately identify fraudulent activity. Have more questions? Contact the Whistleblower Hospital Fraud Law Firm.