Florida is a popular destination for retirees who want to relax and get some sunshine in their post-employment years. Since the state is home to an older population, it is common for people on Medicare to move here and get their healthcare through the State of Florida. Unfortunately, the high rate of people insured by Medicare means that Florida is a prime target for unscrupulous people looking to take advantage of the system for their own gain.
Though fraud against the government may seem difficult to conceal, it happens more often than one might think. The identification and prosecution of healthcare fraud often requires help from those witnessing it, and Tycko & Zavareei LLP is here to help those people come forward. Our lawyers have extensive experience in Florida Medicare fraud cases and can help you blow the whistle on fraudulent Medicare claims in the Sunshine State.
The Who and What of Medicare Fraud
In order to understand how Medicare fraud happens in Florida, one must understand fraud against the government. Government fraud refers to an action taken by an individual or organization attempting to claim money or benefits from government programs to which they do not have a legitimate claim. It is a form of theft, not only from the government, but from the citizens paying taxes into the programs.
Fraud against the Medicare system comes in different forms and can be committed by healthcare professionals such as doctors and nurses. Fraud can also happen on the back end within a billing and coding office without the knowledge of the healthcare provider.
Medicare Fraud in Florida
Medicare fraud is relatively common in places like Florida with older populations. In February 2022, 10 individuals in the healthcare industry were indicted on charges of Medicare fraud in Florida after 18 months of deception. The individuals were charged for accepting kickbacks, as well as both healthcare fraud and conspiracy to commit healthcare fraud.
From 2020 to 2021, the individuals in this case performed medically unnecessary testing and accepted kickbacks in order to receive more money from the Medicare system. A few of them even laundered money to accomplish their goals. Florida Medicare fraud cases such as this one result in financial losses for the government and taxpayers, decreased quality of care for those who need it, and loss of trust in healthcare providers. Tycko & Zavareei LLP understands the far-reaching harm caused by Florida Medicare fraud and works with whistleblowers to put a stop to it.
How Does Medicare Fraud in Florida Happen?
The crime itself takes place behind closed doors using different methods to increase financial gain and avoid detection. What methods do people use to commit Medicare fraud in Florida?
Mis-coding is common because it can be easily disguised as simple error. A universal alphanumeric code is used to bill insurance companies and Medicare for healthcare costs, and genuine errors are not uncommon while coding. However, these errors can be taken advantage of if a provider deliberately codes the service a patient received as a different service – often a more expensive one.
Billing twice for the same service, billing for a service that was never provided, and providing medically unnecessary services are just a few more of the ways people may try to defraud the Medicare system in Florida.
What is a Whistleblower?
If healthcare providers committing fraud are careful to avoid detection, how do authorities catch wind of fraudulent activity? The process of stopping Medicare fraud in Florida usually begins with a whistleblower.
Merriam-Webster defines whistleblower as “an employee who brings wrongdoing by an employer or by other employees to the attention of a government or law enforcement agency.” These employees often notice inconsistencies that raise alarm for them but which would look completely normal to a non-employee.
Whistleblowers are privy to information that Medicare does not have. For example, an employee at a Medicare Administrative Contractor (MAC) receives a bill from a physician’s office stating that a middle-aged patient was given a cardiac stress test to find the reason for a previous abnormal EKG. To the MAC, this would be a reasonable step to take. Nothing appears “off” about the treatment, so they approve the reimbursement.
The nursing assistant at the physician’s office, on the other hand, sees the bill and is confused as to why the stress test was ordered. They saw the patient’s EKG and knows there was nothing on it that indicated a need for a stress test. The nurse becomes suspicious that their workplace is participating in Medicare fraud and can work with a lawyer to blow the whistle on the illegal activity.
How Do I Report Medicare Fraud in Florida?
If you notice signs of a potential Florida Medicare fraud case at your workplace, you can make a protected disclosure under the False Claims Act. This law enshrines protections and rewards for people who blow the whistle on fraud against the government.
Your first step will be to meet with a qui tam attorney to review the evidence and see whether your potential Florida Medicare fraud case warrants an investigation. If so, your attorney will file paperwork to begin an investigation and file a lawsuit on the federal government’s behalf against your employer.
The False Claims Act gives whistleblowers the right to anonymity during the investigation portion of your case, and you are also legally protected against any form of retaliation by your employer. Additionally, if your disclosure prompts a lawsuit that results in a settlement paid to the government, you may be entitled to up to 30 percent of that settlement.
If you have witnessed Medicare fraud in Florida, take the first step and speak with an attorney. Tycko & Zavareei LLP has been fighting fraud alongside whistleblowers for years. Contact us today.
