Every year, more than $100 billion in healthcare fraud is committed in the U.S. In many cases, the fraud continues because healthcare workers are scared to report it. They fear retaliation at work or losing their jobs.
If you are aware of fraudulent practices at your workplace, the Houston healthcare fraud attorneys at Powers Law Firm can help you bring this illegal activity to light while protecting your rights.
Types of Healthcare Fraud
Healthcare billing fraud involves manipulating or falsifying information related to the services the patient received in order to get more money. It can happen in several different ways:
- Double billing: Billing more than once for treatments that were only give one time.
- Incorrect billing: Charging for unnecessary treatments or for services that patient didn’t receive.
- Unbundling: Separating tests and procedures to charge more for each one individually when regulations require those services to be billed together.
- Upcoding: Billing for more expensive treatments or services for an illness that a patient does not actually have.
These practices can occur with any type of healthcare practice or involve any type of payment form or insurance company. Medicare fraud and Medicaid fraud are often more commonly seen in the news, but it also happens with private insurance and when billing patients directly.
Laws Against Healthcare Fraud
Depending on the nature of the fraud, there are several different laws that may apply.
False Claims Act: This federal law allows individuals to bring a Qui Tam lawsuit against companies or people who are defrauding the government for financial gain. Medicare, Medicaid and Tricare are government funded programs that help pay for medical care for those on Social Security, low-income families, and military personnel. Those who blow the whistle on frauds that fall under the False Claims Act may even be entitled to 15% to 30% of the funds that the government recovers in a claim.
Anti-Kickback Statute: This federal law prohibits “kickbacks” in the healthcare industry. It prevents companies from offering rewards to healthcare professionals in exchange for referrals of federal healthcare programs’ business.
Health Insurance Portability and Accountability Act of 1996 (HIPAA): This federal law is often associated with protecting the privacy of patients. However, it also outlines several civil and criminal penalties for healthcare fraud and established programs to identify, control and prevent these abuses for private and government-operated healthcare plans.
What To Do If You Suspect Healthcare Fraud
Whistleblowers are those dedicated healthcare and financial professionals who recognize fraudulent practices and take legal steps to stop those responsible. Healthcare fraud whistleblowers often include:
- Healthcare workers: This can include doctors, nurses, pharmacists, sales representatives, hospital administrators and other licensed healthcare workers.
- Financial professionals: This includes benefits coordinators, accountants, and medical coding specialists.
If you are aware of healthcare fraud, reporting it is an important public service that you can provide. When these illegal practices are exposed, it saves millions of dollars of taxpayer money.
Healthcare whistleblower cases have complicated filing procedures and short deadlines, so it’s important to contact an attorney for assistance as soon as possible after uncovering a fraud. At Powers Law Firm, our experienced Houston healthcare fraud attorneys can help you. Contact us today for immediate assistance.