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Healthcare Whistleblowers: Let’s talk about the key signs of kickback schemes, and what to do when you see one.

You’re a healthcare worker who is considering joining the ranks of healthcare whistleblowers. You’ve been in the game long enough to know a kickback scheme when you see one. You’re pretty sure that something illegal is going down in your workplace or with one of your clients. Here are some signs of kickback schemes to help confirm illegal behavior.

Signs of a Healthcare Kickback Scheme

You might think you know what a kickback scheme is until you need to report one. That’s when the doubt can creep in and make it seem a little less cut and dried. Take a look at some signs of a healthcare kickback scheme to help give you clarity:

You’re seeing patients referred for care that they don’t need.

One of the most common methods of kickbacks is agreement with a physician or company to refer patients with the goal of collecting government medical care income. These referrals happen even when the patient doesn’t need the service. Many patients don’t question whether they need care, especially when their insurance covers it. The specialist receives the Medicare payment for the test. The referring doctor receives a pre-agreed upon cash kickback or part of the Medicare payment. This may require you to do a little – or a lot – of research. When you’re seeing patients referred for tests, a simple search can give you more information on the purpose of the test.

Cash is coming in, but it doesn’t show up in the books.

If you run the business side of things, you might notice extra income coming into the business. Be especially concerned with cash payments that do not fit with services rendered. This can be tough to track if you work in an office where cash payments are common. It’s easier to prove this as a part of a kickback scheme if your patients typically use insurance or pay using credit cards.

You see referrals for care before a healthcare professional even meets with the patient.

It a doctor refers a patient without seeing them, a kickback scheme could be in progress. A doctor needs to meet with a patient to assess their condition before deciding what types of testing might be necessary. If you’re asked to call and set up a referral appointment before the patient sees a doctor in the practice, it’s possible that it’s a kickback arrangement.

Giving the same diagnoses to patients with very different symptoms.

It’s possible that the company or care provider that a doctor has an agreement with only treats one type of condition. The diagnosis of the particular condition must be in their file for the Medicare money to come through. If this is the only indicator you’re seeing, be aware and keep your eyes out for more similar cases and diagnoses.

Gathering Information

If you’re working at a healthcare office where a kickback scheme is in place, it may seem obvious to you that something illegal is happening. If this is the case, it’s critical that you gather evidence. Small nuances, offhand comments, and small financial details can all add up during an investigation. Keep track of the services or diagnoses you’re questioning, the provider at fault, the dates of service, and the reasons that you believe Medicare shouldn’t have paid for the service in question.

Why Not Report Anonymously?

As a healthcare professional, you know that you have the option to report healthcare fraud anonymously. This can prevent your employer from ever finding out that you were the one who filed the suit. Why should you file a qui tam suit? When you file without hiding your identity, the government can talk with you and get more information, helping them to hold the guilty party accountable.

As a way to encourage citizens to report fraud, qui tam laws also entitle reporters to a percentage of the money that the government recovers in the suit. They will also protect you from job loss and employer retaliation. If you lose your job due to reporting, qui tam laws will help you get reinstated. There is also the potential for double back pay for wages lost during the time you were out of work might.

If you’re aware of healthcare fraud including kickback schemes, you know that you need to do the right thing: report it. Qui tam laws will protect you, and our qui tam lawyers will help. We know how to get you the money you deserve for doing the right thing and reporting fraud. Find out everything you need to know about healthcare whistleblowers by contacting Bothwell Law Group.