Medicare spent about $900.8 billion providing health coverage to more than 60 million people in 2021. The program loses billions of dollars yearly because of scams and fraudulent claims filed by dishonest and opportunistic physicians, assisted living homes, pharmacies, labs, hospitals, and other healthcare facilities.

Problems with Medicare fraud did not happen overnight—experts started looking more closely at faulty Medicare billing practices in the 1990s. Since then, scams have been on the rise, and the program has remained susceptible to schemes to claim more money than is right. There are known cases of large hospitals and healthcare facilities changing medical records and billing codes to collect more money, resulting in billions of dollars in unauthorized Medicare payments.

The government uses different methods to crack down on unethical physicians and healthcare facilities, including whistleblowers. Tycko & Zavareei LLP is a credible whistleblower law firm, and we help people aggressively report healthcare fraud, protect their reputation and jobs, and often recover significant financial rewards.

What is Medicare Fraud?

Medicare fraud happens when a corrupt physician, nursing home, or healthcare facility intentionally gives false information to Medicare or its beneficiaries in exchange for unauthorized reimbursements or higher payments.

Medicare fraud is a big business built on exaggerated diagnoses of medical conditions, double or overbilling for services, and billing for medically-unnecessary supplies or services. The insurance program is an appealing target for unethical providers and healthcare facilities as there is insufficient resources and few agents to monitor and track submissions, among other things.

The National Health Care Anti-Fraud Association claims taxpayers are losing more than $100 billion a year to Medicare and Medicaid fraud. The government has difficulty keeping up, but whistleblowers can help bridge the gap.

Signs of Medicare Fraud You Should Not Ignore

Physicians and healthcare facilities can manipulate the Medicare system differently, using inflated charges and higher-cost services or abusing inflated or double billing practices.

Thousands of doctors have steadily billed higher rates for treating elderly patients over the last decade, adding about $11 billion or more to their fees, according to The Center for Public Integrity. Suspicious patterns and the following signs of misconduct might indicate a bigger problem in your organization, including:

• Padding of legitimate claims and billing for procedures or services that never took place.
• Upcoding or billing for more expensive services that never took place.
• Performing medically unnecessary services to generate insurance payments.
• Misrepresenting non-covered treatments as medically-necessary treatments.
• Falsifying a patient’s diagnosis and medical record to justify tests, surgeries, or other procedures.
• Unbundling or billing for every step of a procedure.
• Billing a patient more than a required co-pay amount for prepaid services.
• Accepting kickbacks for patient referrals.
• Waiving patient co-pays or deductibles for medical or dental care and over-billing the insurance carrier or benefit plan.

Specific healthcare positions will require different kinds of proof regarding fraudulent claims. Tycko & Zavareei LLP is a reputable healthcare fraud legal resource, and we can help you gather evidence and determine the next steps on your whistleblower journey.

Blowing the Whistle on Medicare Fraud in Arizona

Medicare fraud endangers vulnerable seniors, jeopardizes quality care, and hurts taxpayers which is why it is so important to put a stop to it. If you have knowledge of an employer or another party manipulating billing codes, billing for unnecessary services, billing for services never provided, or a similar practice to receive more funds from Medicaid and Medicare than they are actually owed, you should consider reporting it.

Blowing the whistle helps the government recover taxpayer dollars and ensure more people are not harmed. In addition to doing what is right, whistleblowers also have a financial incentive to report Medicare fraud—they can claim up to 30 percent of the total amount recovered in a successful case.

Tycko & Zavareei LLP helps whistleblowers with legitimate proof of Medicare fraud file a qui tam lawsuit, a provision of the False Claims Act that allows Arizona-based and other healthcare workers to sue on behalf of the government.

Arizona Medicare Fraud Cases

Medicare and Medicaid schemes have taken hundreds of millions of dollars from the people of Arizona and many other states. Fraud preys on the most vulnerable population, and there are many notable cases in the state, including:

• Banner Health settled False Claims Act allegations that some of its Arizona hospitals submitted false claims to Medicare by admitting patients who could have been treated on a less costly outpatient basis. The health facility agreed to pay $18 million.
• AZ Urogynecology and Pelvic Health Center, an urogynecology practice with multiple Arizona-based locations, entered into an $877,474 settlement with the government in response to allegations it submitted claims to Medicare for items or services that were never provided, including medical equipment, therapeutic services, and unethical billing practices, like unbundled procedures.
• Hospice of Arizona and American Hospice Management reached a $12 million settlement in response to False Claims Act violations. The health facilities submitted false claims to Medicare for patients who did not need end-of-life care or for whom the hospice billed Medicare at a higher reimbursement rate than entitled.

There are safe and secure ways to report fraud, and whistleblowers are protected from hostile consequences, like employer retaliation. The experienced whistleblower lawyers with Tycko & Zavareei LLP can preserve your interests.

How Does the False Claims Act Fight Medicare Fraud in Arizona?

The government funds healthcare through Medicare, Medicaid, and other programs. Medicare fraud directly impacts the government and violates the False Claims Act. This law makes fraud committed against the government or government programs funded by taxpayer dollars illegal.

The False Claims Act protects and rewards whistleblowers through the qui tam provision. It allows private citizens with information regarding fraud to file a claim on behalf of the government in exchange for compensation. Rewards can be substantial, such as millions of dollars.

Questions about whistleblower protections, the False Claims Act, or Arizona-specific whistleblower laws can be answered by an experienced whistleblower lawyer.

Arizona Whistleblower Laws

The Whistleblower Protection Act (WPA) allows federal government employees to come forward with reasonable evidence regarding fraud or a person or company’s violation of law, rules, regulations, mismanagement, or gross waste of funds or abuse that endangers the public’s health and safety. Federal employees also are protected from whistleblower retaliation should an employer threaten to, or take, retaliatory action like verbal harassment, demotions, layoffs, denied vacation time and more.

Arizona’s whistleblower laws, including the Arizona Employment Protection Act, follow similar principles, but it protects private and public-sector employees who have been terminated or constructively discharged after reporting Medicare fraud or other illegal activities. These whistleblower laws ensure you can voice concerns without fear of repercussion, and our qualified legal team will protect you from losing your job.

Medicare and healthcare fraud whistleblowers can anonymously file a qui tam lawsuit under the False Claims Act with the help of an experienced whistleblower law firm. If the government finds evidence of fraud and they pursue the case, you could be entitled to a percentage of recovered funds.

Defeat Medicare Fraud: Talk with a Reputable Arizona Whistleblower Law Firm

Everyone shares the burden when at-home healthcare facilities, nursing home staff, and physicians de-fraud the government and hurt innocent people. Medicare and healthcare fraud are a top priority in America, and many of the Medicare and Medicaid cases recovered by the Department of Justice are all thanks to reports from whistleblowers.

Tycko & Zavareei LLP and our experienced qui tam legal team have helped whistleblowers in Arizona and throughout the country file successful health care fraud qui tam cases. For example, we helped two whistleblowers reach a 5.7 million dollar settlement and a 21 percent whistleblower reward against an online pharmacy that de-frauded Medicare and Medicaid. There are many other health care and Medicare fraud stories just like this one.

Medicare abuse, waste and fraud impact government officials, insurers, premium-payers, healthcare providers and seniors. It is a costly reality that can no longer be overlooked, and you can help protect the integrity of our nation’s health system and its resources with just one phone call.

If you have evidence of fraud inside your health care facility, contact our whistleblower lawyers today for a free and confidential case evaluation.