In an attempt to simplify and encourage more citizens to blow the whistle on Medicare fraud, Medicare whistleblower hotlines have been set up throughout the country. The purpose of a Medicare whistleblower hotline is to provide an easy and anonymous way for employees to report evidence of suspected illegal activity within their workplace.
There are various reasons why an employee may call a Medicare whistleblower hotline, but there are some reasons that are more common than others. Continue reading for the top 5 reasons the Medicare whistleblower hotline is called:
#1. Billing for a service that was not provided.
A healthcare provider may be routinely billing for procedures, most commonly diagnostic tests, that they have not provided to a patient. When the patient receives the incorrect statement, they typically call their provider first instead of Medicare that allows for this type of fraud to go unnoticed.
#2. Billing for supplies that were not provided.
Similarly to the scenario above, some providers may routinely bill Medicare for a supply under the false pretense that they have supplied it to a patient.
#3. Up-coding to be reimbursed at a higher rate.
Some healthcare providers may make a habit of up-coding, or billing a service as a higher paid procedure or test that was not performed. As an employee, reporting this type of fraud is incredibly important since an estimated 2% of Medicare claims are audited for up-coding.
#4. Misrepresenting a diagnosis or procedure.
If a procedure is not covered under Medicare, some healthcare providers will code it inaccurately to obtain reimbursement for that service. Additionally, since Medicare can only cover services that have been deemed as absolutely medically necessary, some healthcare providers will misrepresent a diagnosis as a way to obtain reimbursement for a service that would not be covered under normal circumstances.
#5. Billing bundled services individually.
There are multiple services, especially surgical or diagnostic services, that are bundled together to be billed as one service. In some cases, providers are unbundling these services and billing them separately across several bills as a way to receive additional compensation for a service provided.
The desire to submit an anonymous tip concerning Medicare fraud is completely understandable as many employees fear retaliation at the hands of their employer. However, there are laws in place that protect whistleblowers from retaliation. Although an anonymous call to a Medicare whistleblower hotline is helpful, lawsuits presented with evidence of fraud are more highly prioritized by the government and anonymous whistleblowers cannot be rewarded if the defendant is found liable.
Bothwell Law can assist you in filing a Medicare False Claims lawsuit and teach you what you need to know to protect yourself from retaliation. Find out what you need to know about the Medicare whistleblower hotline by clicking this link or calling 770.643.1606.
