Nearly every American has relied on the healthcare system at some point in their life. Whether they have fallen ill themselves, had an unwell child, or been by the side of a sick loved one, almost everyone has had to place their trust in the hands of a doctor, hospital, or medical practice. For more than 100 million Americans, publicly-funded insurance programs are how they are able to access affordable healthcare.
Healthcare fraud occurs when a medical professional, hospital, or practice cheats the government for their own gain by claiming more funds from Medicare, Medicaid, Veteran’s Affairs, or another federally-funded insurance program. As much as we would like to believe that every healthcare facility is committed to and motivated by their patients’ well-being and quality of life, this is unfortunately not always the case.
If you have knowledge of healthcare fraud, you may be eligible for a financial reward for speaking up. Contact the Champaign healthcare fraud lawyers of Tycko & Zavareei LLP to learn more in a confidential consultation.
What is Healthcare Fraud?
Healthcare fraud is when a medical professional or practice deceives someone into paying more than they needed to for medical services. One of the most common types of healthcare fraud is fraud against the government. This happens when a healthcare provider deliberately misrepresents information while billing Medicare, Medicaid, the VA, or another government-run health care program in order to secure illicit financial gain or additional benefits.
Common Types of Champaign Healthcare Fraud
Healthcare fraud happens more often than you might think, in plenty of different ways. A few common ways that healthcare practices may get away with fraud can include, but are not limited to:
Double Billing
Double billing is a fairly simple practice that involves billing an insurance provider twice for a single service that took place. Services and procedures can be billed twice by mistake, which can sometimes make it easier to conceal double billing for the purpose of perpetrating Medicare or Medicaid fraud. Double billing does not always look suspicious at first and could easily be a simple clerical error. As an employee, it becomes especially important to watch out for patterns or frequent mistakes when billing government-funded programs.
Mis-Coding
Since there is a myriad of different treatments and procedures in the healthcare field, processes are billed by an alphanumeric code that indicates what services the patient received. At times, billing staff or healthcare professionals will intentionally enter an incorrect code (usually for a more expensive service) and bill the government for the higher amount.
Kickback Schemes
Kickback schemes are a form of bribery between a pharmaceutical company and a physician or medical facility. The physician may accept some form of payment or gift in exchange for prescribing medications from that company, even when they are not the best choice for the patient’s treatment. These medications often cost more than their alternatives, and alternative treatments may not even be explained or presented to the patient.
False Billing
False billing is any type of intentional billing error that leads to a medical practice or professional receiving more money than they should. Double billing is a type of false billing. Phantom billing, or billing for services that were never performed, is another.
Champaign Healthcare Fraud: Who Does it Hurt?
Who suffers when someone commits healthcare fraud?
In most cases of Champaign healthcare fraud, the individual patient does not foot the bill for the fraudulent charge. Medicare or Medicaid is billed, and if the fraud is not detected, the charge is paid out to the health care provider. This means that the government, and ultimately taxpayers, take the loss.
However, the long-term effects of fraud against the government, such as Medicare or Medicaid fraud, eventually trickle down to patients themselves. The resources intended to pay for citizens’ care are being used to cover charges that are not legitimate. Federal health care programs are funded by taxpayers, so when a healthcare facility commits fraud, taxpayer money ends up in their pocket.
When working together with Champaign healthcare fraud qui tam lawyers like those at Tycko & Zavareei LLP, those with insider information about fraud (known as whistleblowers) can help to stop it from happening.
How to Spot Healthcare Fraud & Why Say Something
When you let the authorities know that you suspect fraud and help the government uncover it, you become a whistleblower. By speaking up, you help keep the healthcare system as fair as possible, save taxpayers’ money, and assist the government.
All whistleblowers are also protected and rewarded for coming forward under a law called the False Claims Act. In order to avoid unlawful retaliation, the False Claims Act allows whistleblowers to stay anonymous. To encourage people who may know about fraud to speak up about it, the False Claims Act also put rewards into place. If the information you provide leads to a successful lawsuit by the government against someone committing fraud, you may be entitled to between 15 and 30% of the financial settlement from that lawsuit.
Illinois also has its own law, the Illinois False Claims Act, which provides similar protections and rewards to whistleblowers who help uncover entities that intentionally submit fraudulent claims to the State or its municipalities for payment.
Here are a few key things to watch out for that may indicate that healthcare fraud might be occurring.
- Mistakes happening in a pattern: If treatments are being miscoded or billed incorrectly and the mistakes stop after concern is raised, only to start again later, someone may be trying to get away with false billing.
- Unnecessary tests, especially on more than one patient: Sometimes, a doctor may perform unnecessary tests or routinely prescribe the same expensive medication. They may have a legitimate reason for doing so, or they may be trying to obtain more funding from Medicare, Medicaid, or the VA.
Who to Talk To About Healthcare Fraud in Champaign
If you decide to become a whistleblower and report what you have witnessed, who should you go to? Unlike reporting other crimes, you do not simply walk into a police station and file a report. You would need to speak with a Champaign healthcare fraud lawyer.
When you speak to a lawyer at Tycko & Zavareei LLP about your whistleblower case, we will go over the evidence you have and determine whether there is enough reasonable suspicion to launch an investigation. If so, the government may begin investigating. All efforts are made to preserve our clients’ anonymity and make the process as simple as possible. Contact us today to set up a free and confidential consultation.
