Medicare fraud happens everywhere, including in healthcare facilities throughout the Prairie State, and affects everyday citizens and those seeking care. If you have evidence of fraud being committed against Medicare programs, let our whistleblower attorneys help you expose the illegal activity. Here are a few things you should know about Medicare fraud in Illinois.
Medicare Fraud by Healthcare Providers
Medicare fraud against the government is most often committed by a healthcare provider or practice. The intent is to deceive the government and the Medicare system into giving the practice or provider more money or benefits than they are legitimately entitled to receive.
How Do Healthcare Providers Commit Medicare Fraud?
Fraud in the healthcare industry can happen in a variety of ways, some only impacting billing and others directly impacting patient care. Fraudulent Medicare billing may be disguisable as human error, but consistent “errors” that result in gains rather than losses for the healthcare facility constitute fraud. Types of Medicare fraud which occur on the billing end include:
- Double billing, or billing twice for the same service.
- Phantom billing, which occurs when a healthcare provider bills Medicare for a service the patient never received.
- Mis-coding, which takes advantage of the universal code used to bill healthcare services to insurance or Medicare.
- RUG fraud is a type of healthcare fraud unique to senior care facilities. RUG stands for resource utilization group and is a way for skilled nursing facilities to categorize patients according to their healthcare and support needs. Medicare then pays the facility a set amount based on the number of patients in each category, with a higher payout for higher RUG groups. A facility may artificially inflate the higher groups in order to obtain a higher payout from Medicare.
Types of Medicare fraud which directly impact patient care include:
- Medically unnecessary treatment – When more expensive tests or procedures are performed for patients who do not need them.
- Bribes or kickbacks – If a medical professional is accepting benefits or money from a third party such as a pharmaceutical company in exchange for prescribing a certain drug or referring to a particular facility, regardless of whether it would benefit the patient, this is called a kickback and represents dishonest and fraudulent healthcare.
How to Spot Medicare Fraud in the Workplace
Everyday employees are usually the ones who notice Medicare fraud in Illinois and bring it to someone’s attention, since they are right there in an office or on the back end of the billing system and can notice discrepancies. People who notice patterns that look like Medicare fraud and take their concerns to a lawyer are called whistleblowers, and they are an essential part of our justice system. Tycko & Zavareei LLP is a qui tam law firm with years of experience working with whistleblowers all over the country and helping them obtain rewards for their efforts.
Whistleblowers play an important role in the discovery and cessation of Medicare fraud in Illinois. Employees at healthcare practices may notice that a particular drug is being prescribed in situations that do not seem to require it, expensive procedures are being performed more often than usual or with vague reasoning as to why, or coding “errors” seem to benefit the practice more often than not. What should you do if you suspect fraud in your workplace?
Can I Safely Disclose My Suspicions?
If you are employed in healthcare and have noticed odd behavior or numbers that do not quite add up, there may be Medicare fraud occurring at your workplace. Staying quiet about fraud only allows it to continue. However, many people wonder if doing the right thing will have a detrimental impact on their livelihood and career.
In the United States, there is a law called the False Claims Act that protects whistleblowers who come forward with information about wrongdoing in their workplace and makes it illegal for an employer to take any retaliatory action against an employee who blows the whistle on fraudulent activity. The False Claims Act gives whistleblowers the right to remain anonymous during the initial investigation of the claim, with the potential for a reward should their disclosure lead to a successful lawsuit against their employer.
Because the United States depends on whistleblowers to detect fraud, the government does its best to reward those who come forward. If a qui tam lawsuit results in the government being paid a settlement, the whistleblower may receive a portion of the settlement, usually between 15 and 30 percent.
Speak with an Illinois Medicare Fraud Lawyer
Many people assume that if something illegal is happening, they need to speak with the police. However, whistleblower cases work differently. The person suspicious of fraud would first need to speak with an Illinois Medicare fraud lawyer. Then, if there is sufficient evidence to open a case, the attorney files the paperwork to begin an investigation. This is done to protect the whistleblower’s identity, as well as ensure that the government is well-represented. Qui tam lawsuits are filed on behalf of the government by a lawyer.
It may be a tough decision to take your concerns to a Medicare fraud attorney in Illinois, but the experienced qui tam attorneys at Tycko & Zavareei LLP are familiar with the protocol and will do everything in their power to make the process simple for you. Contact us today to learn more about pursuing a whistleblower case in Illinois.
