When reading the False Claim Act, it may not seem perfectly clear whether unnecessary medical billing is covered by the law. The False Claims Act is a detailed law, covering multiple industries and various types of fraud. If you suspect a healthcare provider of committing fraud, there are a few things you should know before taking action under the False Claims Act.
What Is Unnecessary Medical Billing?
Unnecessary medical billing can take many forms. In some cases, a physician will bill for a service never provided or upcode a service as a more expensive test or procedure in order to obtain further compensation. In other cases, the healthcare provider will intentionally misdiagnose a patient, knowing this diagnosis will enable them to bill for costlier tests and procedures the patient never needed. Another example of unnecessary medical billing occurs when a patient is provided a service or supply they never needed because the healthcare provider is hoping to receive additional funds.
Not All Unnecessary Medical Billing Falls under the False Claims Act
All unnecessary medical billing is wrong, but not all unnecessary medical billing falls under the False Claims Act. This law was specifically created to allow for prosecution of entities which are misusing government funds. This means, any unnecessary medical billing being paid by Medicare or Medicaid will fall under the law. The False Claims Act allow for citizens to act on behalf on the behalf of U.S. government by filing a complaint.
This is compared to cases where a private insurance company is being billed unnecessarily. This type of insurance fraud is not covered under the False Claims Act, but it is illegal. The private insurance company will need to seek out an attorney who can work with them to file a lawsuit on their behalf.
Reporting Medicare or Medicaid Fraud
If you are the employee at an organization which receives reimbursement for services from Medicare or Medicaid and you suspect fraud is being committed, you can become a whistleblower. If you are a recipient of services being paid for through Medicare or Medicaid, you can also report fraud. Many people choose to report fraud through a hotline provider by the Attorney General in their state. However, if you wish to receive up to 25 percent of the recovered funds as a reward for filing a complaint, you must work with an attorney to file a claim.
An experienced whistleblower attorney will be able to guide you through each step of the process. They can make sure you are protected against retaliation for filing the complaint and they can help you take every possible step to increase your chance of receiving a portion of the recovered funds.
At Bothwell Law Group, we are experienced working with whistleblower lawsuits. To learn more about unnecessary medical billing and the False Claims Act, call 770.643.1606.