Whistleblower Medicare Fraud Attorneys

The Whistleblower Firm of Nolan Auerbach & White is a Medicare Fraud Law Firm with lawyers helping whistleblower clients in cases ranging from coding false claims, long term care fraud, DRG false claims, PPS false claims, to outpatient APC false claims, Stark law, and Medicare kickback violations.


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With over 25 years of experience and $6 billion collected and returned to taxpayers since the False Claims Act was amended in 1986, courageous Medicare Whistleblowers call on our Fraud Attorneys with confidence.

Have You Witnessed Medicare Fraud?

Contact the Medicare Whistleblower Attorneys at Nolan, Auerbach & White to get started on a free and confidential review of your important case today. Call our Whistleblower Healthcare Fraud Attorneys at 800-372-8304 today. 


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Whistleblower Medicare Fraud Lawyers - Nolan Auerbach & White

Protecting The Medicare Fraud Whistleblower

Private citizens play a critical role in reporting healthcare fraud. Under the qui tam provisions of the False Claims Act, 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. Contact us online or call us at 800-372-8304 to get started. Your interaction with our qui tam attorneys is confidential.

Have You Witnessed Medicare Fraud?

If you are aware of Medicare fraud, the law protects you as a whistleblower. We encourage you to begin this important duty and service by scheduling a free review of your case today with the Medicare Fraud Attorneys at the Whistleblower Firm. Contact us online or call us at 800-372-8304 to get started. Our qui tam lawyers, with more than 25 years of experience, will keep all interactions confidential.

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REPORT MEDICARE FRAUD 


What Is Medicare Fraud and Abuse?

Fraudulent activity with Medicare typically happens when there is a violation of the False Claims Act. Fraud can be categorized by provider type and fraud scheme. Violations are made by providers such as hospitals, skilled nursing facilities, home health agencies, pharmacies, HMO’s and physician groups. The Medicare fraud lawyers at Nolan, Auerbach, and White have broad familiarity with these areas.

Potential False Claims Act violations include the following:

  1. Billing for services not rendered or products not delivered
  2. Billing for services or supplies not ordered
  3. Misrepresenting services rendered or product provided, e.g., upcoding, inappropriate coding
  4. Billing for medically unnecessary services
  5. Duplicate billing
  6. Billing procedures over a period of days when all treatment occurred during one visit
  7. APC fraud
  8. Upcoding
  9. Diagnosis-Related Group fraud
  10. RUG upcoding
  11. Hospice fraud
  12. Part A Admissions that lack medical necessity (inpatient, observation)
  13. Case-mix creep
  14. Medicare-funded managed care fraud

If you have become aware of any of these types of activities, our firm of Medicare Fraud Lawyers can help when you’re ready to learn more about the qui tam process and Report Medicare Fraud.

How To Report Medicare Fraud

Our Medicare 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 Medicare 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 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.

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Medicare Fraud: Parts A through

The Medicare program consists of four parts, and accordingly, fraud corresponds to these four categories. The Medicare Fraud Attorneys at the Whistleblower Firm are available to discuss each of these with you during a free case consultation. 

Medicare Part A Fraud 

Medicare Part A authorizes the payment of federal funds for hospitalization and post-hospitalization care. This typically includes payments to hospitals, skilled nursing facilities, home health agencies, and similar under the Prospective Payment System (PPS). 

Insurance companies that process Medicare Part A claims are referred to as Medicare Administrative Contractors. 42 U.S.C. § 1395h.

Part A violations may include:

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

Contact our Medicare Fraud Attorneys today to report Part A violations. 

Medicare Part B Fraud

Medicare Part B authorizes the payment of federal funds for medical and other health services, including, without limitation, physician services, supplies, and services incident to physician services, laboratory services, outpatient therapy, diagnostic services, and radiology services.

Insurance companies that contract with the Centers for Medicare & Medicaid Service (CMS) to process Medicare Part B claims are known as Medicare Administrative Contractors (MACs). They process and pay billions of dollars of Medicare benefit claims on behalf of the federal government.

When services are covered under Part B, Medicare then uses one of the two following payment methods: (1) payment to the patient; (2) “assignment” method – payment to the hospital, doctor (or other healthcare entity or supplier). 

Part B violations may include:

  • Laboratory unbundling or upcoding
  • Billing for services not rendered or products not ordered
  • Increasing units of service that are subject to a payment rate
  • Misrepresenting services rendered or products provided (e.g., upcoding, unbundling)
  • Falsifying records to meet or continue to meet the conditions of payment or participation
  • Billing for medically unnecessary services

Contact our Medicare Fraud Lawyers today to report Part B violations. 

Medicare Part C Fraud

Part C of the Medicare Program, known as Medicare Advantage, allows Medicare beneficiaries to obtain their medical benefits through private managed health care organizations (“MA Organizations”). Under this program, MA Organizations enter into contracts with CMS, according to which CMS pays each MA Organization a set amount for each Medicare beneficiary it enrolls, depending upon the beneficiary’s risk adjusted score. In exchange, MA Organizations agree to provide their Medicare enrollees with, at a minimum, all the benefits the beneficiary would be entitled to receive under the original Medicare program. Medicare’s payments to the managed care plan replace the amounts Medicare otherwise would have paid under traditional Medicare.

Part C violations may include:

  • MA Organization’s and physician relationships that are driven by cost-containment at the expense of patient care
  • Intentional failure to pay providers or provide necessary and reasonable services to beneficiaries
  • Inflated general and administrative costs
  • Upcoding Diagnoses in the CMS’s Managed Care Organization encounter data system and/or the risk adjustment processing system. 

Contact our Medicare Fraud Lawyers today to report Part C violations. 

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 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.

Medicare pays claims based upon a bare electronic submission indicating that certain supplies or services for a particular patient covered by Medicare have been rendered or furnished. Beyond computer edits, only minimal verification or due diligence exists before payment is made.

Part D violations include:

  • Submitting claims or other false documentation to multiple payors for the same prescription (except as required for coordination of benefit transactions)
  • Submitting claims or other false documentation for non-covered drugs 
  • Off-label marketing by pharmaceutical manufacturers
  • Submitting claims or other false documentation for drugs not provided
  • Submitting claims or other false documentation for brand name drugs when generics are dispensed
  • Unlawful kickbacks provided to physicians, to the dispensing provider, the Part D Plan, or the submission of false information in connection with obligations under the Discount Program Agreement.

Contact the Whistleblower Firm’s Medicare Fraud Lawyers today to report Part D violations. 

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Federal Laws for Whistleblowers

For decades, Healthcare Fraud cases have brought the most significant return to the U.S. Treasury. Many of these cases, and the resulting returns to the public fisc, were made possible by brave whistleblowers stepping forward to expose clear cases of fraud. Using the qui tam provisions under the False Claims Act, these individuals were able to stop fraud and have cumulatively been awarded hundreds of millions of dollars for their part in stopping this fraud. Medicare Fraud Attorneys play a significant role in guiding clients through these complex legal battles. 

Two Federal laws which proscribe illegal conduct, in addition to the FCA, are the STARK LAW and ANTI-KICKBACK LAW.

The Stark Law and Medicare Abuse

The Stark law, 42 U.S.C. §1395nn, is also known as the Physician Self-Referral Law. If a physician (or immediate family member) has a direct or indirect financial relationship (ownership or compensation) with an entity that provides any of certain designated health services (“DHS”), the physician cannot refer patients to the entity for DHS, and the entity cannot submit a claim to Medicare for such DHS unless the financial relationship fits in a statutory or regulatory exception.

The Stark law was intended to prohibit physicians from profiting (actually or potentially) from their own referrals. The Stark law acts to sanction improper physician referrals by providing penalties for illegal referrals prospectively. Its effect is to prohibit relationships that have been demonstrated to encourage over-utilization. It is a strict liability statute, i.e., there is no need to show knowledge or intent.

The Medicare program depends on physicians and other health care professionals exercising independent judgment in the best interests of patients. Hospital admissions that lack medical necessity, for instance, are not in the best interest of the patients, as patient harm can result. 

Financial incentives tied to referrals tend to corrupt the health care delivery system in ways that harm the federal programs and their beneficiaries. Corruption of medical decision-making can result when a physician refers a patient to a provider based on the physician’s financial self-interest instead of the patient’s best interests.

Each of these may represent financial windfalls to physicians resulting in hospital referrals in violation of the “Stark law.” 

Get a Medicare Fraud Attorney on your side. Start your free case review today.

The Anti-Kickback Statute and Medicare Violations

The other law is the federal Anti-kickback Statute, 42 U.S.C. § 1320a-7b(b). It arose from congressional concern that payoffs to those who can influence healthcare decisions will result in goods and services being provided that are medically unnecessary, of poor quality, or even harmful to a vulnerable patient population. To protect the program’s integrity from these difficult-to-detect harms, Congress enacted a per se prohibition against the payment of Medicare kickbacks in any form, regardless of whether the particular kickback gave rise to overutilization or poor quality of care.

The Anti-kickback statute prohibits any person or entity from making or accepting payment to induce or reward any person for referring, recommending, or arranging for federally-funded medical services, including services provided under the Medicare, Medicaid, and TRICARE programs.

Contact a National Medicare Fraud Law Firm Representing Whistleblowers

Our team of Medicare fraud lawyers has helped our clients in cases that have included coding false claims, long-term care fraud, DRG false claims, PPS false claims, outpatient APC false claims, Stark law and Medicare kickback violations, and other types of Medicare fraud. 

Medicare has been amended and expanded many times since it was enacted in 1965, and although efforts have been made to curtail Medicare fraud, we still have a long way to go. Medicare fraud has cost taxpayers billions over the last decade, but with the help of whistleblowers, a significant portion has been returned to the U.S. Treasury.

The elimination of third-party payments (“assignment of benefits”) directly to other providers, instead of reimbursement of the beneficiary will help. However, cracks in the system still exist. Healthcare fraud is simply ripe for disclosure by Medicare whistleblowers. The qui tam provisions of the False Claims Act are available as an incentive for Medicare fraud whistleblowers to come forward and expose fraud.


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Medicare Fraud Reporting Requirements & Other Resources

It’s time to report the Medicare you’ve become aware of. Join the many whistleblower heroes that have exposed violations of the law by taking a stand for justice. Contact our team of Medicare Fraud Lawyers today. It could result in you sharing a percentage of the funds recovered from fraudulent activity. 

Healthcare Fraud Lawyers - Nolan Auerbach and White - The Whistleblower Firm

Report Medicare Fraud and Other Corruption 

Our law firm representing whistleblowers has the experience to discuss in-depth areas of Healthcare Fraud. Here are additional abuses our Medicare fraud lawyers encourage whistleblowers to report:

Get started by filling out our online form for potential clients, or give Nolan, Auerbach, and White and our experienced team of Qui Tam Medicare fraud attorneys a call today at 800-372-8304.

 


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Frequently Asked Questions About Medicare Fraud Lawsuits


What Happens When You Report Medicare Fraud?

 

When a whistleblower reports Medicare Fraud through a qui tam case, rewards are available. Our whistleblower law firm can guide you through the qui tam process and represent you in your case. We will evaluate your potential case to determine liability and damages.


How Much Medicare Fraud Is Present In The United States?

 

The Centers for Medicare and Medicaid Services estimates that improper payments in 2020 were approximately $25.74 billion, about 6.27 percent of payments.


What Is Abuse In Medicare?

 

Medicare abuse occurs when practices contribute either directly or indirectly to unjustified costs to the Medicare Program. This covers a wide range of practices including lack of medical necessity. If you are aware of Medicare fraud and abuse, contact our Healthcare Fraud Law Firm.

Kathleen Hawkins

Dignity Health
$37 million

Kathleen Hawkins, RN MSN, had been employed by Defendant, Catholic Healthcare West (CHW) for approximately 6 years when she decided she had had enough of trying to change the hospital system from within.

CHW, a California not-for-profit corporation that operated hospitals in California, Arizona, and Nevada, was at the time the eighth largest hospital system in the nation and the largest not-for-profit hospital provider in California.

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Joe Strom

Johnson & Johnson
$184 Million

Joe Strom contacted us in 2005. We were very grateful that he did. We immediately formed an all-star legal team and a process to stop a very harmful pharmaceutical marketing strategy. It was this process we set into motion that ultimately returned hundreds of millions of dollars to the U.S. Treasury, and a portion of that, very well-deserved, into Joe’s bank account.

Joe told us a very troubling story about the off-label promotion of a pharmaceutical drug for patients who already suffered from chronic heart failure.

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Bruce A. Moilan Sr.

$27 Million

Bruce Moilan was a seasoned hospital systems expert by the time he contacted our Firm. At the time he decided to file his qui tam lawsuit, he was employed by South Texas Health System as a System Director for Materials Management. In this position, he oversaw $24 million in annual purchases of supplies and equipment and helped determine budget, reduction and cost analysis throughout the contract bidding and negotiations process. His job was to insure proper implementation for purchasing, receiving and management of inventory, for McAllen Hospitals, L.P.

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Am I potential whistleblower that matches up well with our firm?

We only want to represent amazing people.

How much will I make?

We cannot guarantee anything, but we will deliver on this promise: we will give you feedback and a prognosis within 48 hours of your submission of all details to us. We are the first healthcare fraud qui tam law firm, and have been doing only healthcare fraud whistleblower lawsuits for decades-so you can expect as accurate a picture as is possible.

Are my communications with you confidential?

They are 100% confidential. If we do not take your case, your information becomes inaccessible. We have no interest in it. Besides, it is protected by the attorney-client privilege under our lawyer regulations, and we would lose our license if we were to disclose one iota of information about you or your potential case.

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    The more detailed the response, the more likely it is that we will be able to evaluate and determine if your potential False Claims Act case falls within our case requirements. IF IT DOES, WE WILL RESPOND TO YOU WITHIN 24 HOURS. (Names of potential defendants are not necessary at this point, should you feel more comfortable omitting them.) By law, all communications to us are 100% confidential.

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    Please read the following statement and then click "Send Form":

    Any response to your e-mail will be solely to communicate about our possible representation of you under the qui tam provisions of the False Claims Act. All e-mails submitted to us, whether we take your case or not, are 100% confidential. If we do not respond to your e-mail, then you have communicated information which we cannot address because it appears to fall outside of the False Claims Act or our case requirements.