Millions of people put their trust in the American healthcare system every day to provide quality care to anyone who needs it and keep the population healthy and safe. Unfortunately, some healthcare facilities and providers take advantage of that trust and defraud government programs such as Medicare and Medicaid for their own gain.
At first glance, it may seem like the only group impacted by healthcare fraud is the government. After all, they are the ones losing money as a result. However, the effects of this type of fraud trickle down and end up either directly or indirectly affecting everyday citizens. Tycko & Zavareei LLP’s qualified Florida healthcare fraud lawyers are here to put a stop to fraud with the help of whistleblowers. Contact our qui tam attorneys to learn more.
Where Does Healthcare Fraud Occur in Florida?
Healthcare fraud is unfortunately common in Florida and can be found in various types of healthcare facilities. Examples of places that commonly see instances of healthcare fraud in FL include:
- Doctors’ offices
- Private healthcare practices
- Hospitals
- Labs
- Nursing homes
Medicare and Medicaid Fraud
Medicare and Medicaid fraud are two prominent types of healthcare fraud against the government. Medicare fraud is especially common in Florida because of the number of retirees that settle here after their working years.
Defrauding the Medicare and Medicaid systems directly impacts the government, which loses money with every case of fraud, but it also harms seniors and the underprivileged. The money that the government loses in these fraud cases is intended to go toward medical services for those who may otherwise have trouble affording care, thereby placing vulnerable populations at an even greater disadvantage.
Other Types of Healthcare Fraud
Healthcare fraud in Florida happens in a variety of ways. It usually occurs in the billing office, but it can directly impact patient care in other ways. Here are a few common types of healthcare fraud in FL:
- Providing services a patient does not need. At times, a healthcare provider will run a test or perform a procedure that they know a patient does not need solely so they can bill Medicare or Medicaid for the cost and collect reimbursement.
- Deliberately entering the wrong code for a patient’s care. When a billing office enters an incorrect code for a healthcare service to receive reimbursement from Medicare for more than the value of the service that was actually rendered or needed, it is known as “upcoding.”
- Billing services incorrectly. Whether the practice charges for services that were never rendered (“phantom billing”), charges services at a higher rate, or bills twice for a service that was only rendered once, incorrect billing (or “overbilling”) is a relatively common form of healthcare fraud in Florida.
- Accepting kickbacks. “Kickbacks” are bribes offered by healthcare facilities to physicians to get them to refer patients to them, regardless of whether it is the best choice for the patient. Pharmaceutical companies may also offer kickbacks in exchange for a medical professional prescribing their new drug or device to patients.
Reporting Healthcare Fraud in Florida
You may think that there is nothing you can do if you notice healthcare fraud occurring in your workplace. Many people are intimidated by the idea of reporting fraud due to fear of retaliation by their employer. They may not realize that there are protections in place for people who report fraud (often called whistleblowers) at both the federal and state levels.
Reporting Healthcare Fraud Committed against the Federal Government
The federal False Claims Act is a law that was passed during the Civil War and has undergone a few amendments since to become what it is today: a way for whistleblowers to safely report their concerns. It specifically prohibits retaliatory action against whistleblowers; that is, punitive actions taken in direct response to a worker blowing the whistle. Examples of retaliatory actions include pay cuts, departmental transfers, and even termination.
Additionally, paperwork for a protected disclosure under the False Claims Act is always filed through an attorney in order to protect the whistleblower’s identity. Tycko & Zavareei LLP fully understands the importance of privacy for a whistleblower. We do everything in our power to protect our clients’ identities and ensure their safety.
The False Claims Act also rewards people who give information that leads to a successful qui tam lawsuit. If someone blows the whistle on healthcare fraud in Florida and the government is able to recover a settlement based on that disclosure, the whistleblower may be entitled to a portion of the settlement.
Reporting Healthcare Fraud Committed against the Florida State Government
Similar to the federal False Claims Act, the Florida False Claims Act rewards whistleblowers who report healthcare fraud committed against Florida’s Medicaid program. The whistleblower may receive up to 30% of the total amount of money recovered.
How Do Whistleblower Lawsuits Work?
In cases of healthcare fraud, the whistleblower (with help from their attorney) files a lawsuit on behalf of the government. Even though the whistleblower starts the qui tam lawsuit process and is entitled to a reward in the event that the lawsuit is successful, they are not the plaintiff.
Contact a Florida Healthcare Fraud Attorney
Reporting healthcare fraud in Florida can be an intimidating process at first, but having a strong and experienced lawyer on your side is key. Tycko & Zavareei LLP’s expert team has been fighting fraud for years. We know the qui tam lawsuit process well and have worked with whistleblowers all over the country. Contact us today through our website to schedule free and confidential case evaluation.
