The lower cost and wide array of healthcare providers to choose from make Medicare an attractive insurance option for any retirement-age American. Funded by the United States government, Medicare provides a cost-effective means of paying for healthcare for adults 65 years and older.
Since Medicare is such a large and widely used program, it is often the target of fraud. Fraud against the Medicare system can take many forms, either directly or indirectly affecting individuals who receive their care through the government-funded program. Tycko & Zavareei LLP’s Medicare fraud lawyers in Los Angeles are here to support individuals with knowledge of fraudulent Medicare claims. Our attorneys can support you on your whistleblower journey.
What is Medicare?
Medicare is a government-funded healthcare program designed to support the medical needs of Americans as they age. To qualify for Medicare, one must be over the age of 65, in end-stage renal (kidney) failure, or have certain qualified disabilities.
Who Commits Medicare Fraud?
It is a common misconception that Medicare fraud is most often committed by individuals who “game the system” by lying about their conditions. In reality, healthcare practices and providers are the most likely culprits of fraud. They may make false claims in order to receive higher payouts from Medicare at the expense of retirement-age Americans and taxpayers.
How Does Medicare Fraud Happen in Los Angeles?
Medicare fraud can take many different forms. The healthcare practice participating in fraudulent activity may switch between these methods to avoid detection, or they may stick with one once they figure out that it works. Here are a few common forms of Medicare fraud in L.A.:
- Upcoding: Alphanumeric coding is used in healthcare billing in order to keep track of what procedures, tests, and medications patients are receiving. The codes are universal so they can be easily understood by any practice or insurance provider. Fraudulent healthcare providers will sometimes intentionally enter the code for a more expensive treatment than what the patient actually received, then pocket the extra money that the government pays out.
- Double billing: The healthcare provider bills Medicare twice for a service that was only performed once.
- Kickback schemes: Kickbacks are essentially bribes given to a physician to get them to refer patients to a healthcare practice with whom they share a financial relationship, regardless of whether it is the best treatment option for the patient.
- False billing: The provider bills Medicare for services that were never rendered.
- Unnecessary services: The provider performs tests or procedures, often expensive ones, that a patient does not actually need in order to bill those services to Medicare.
How Does Los Angeles Medicare Fraud Affect Individuals?
Though it may sound like the government is the only one to lose out when people and healthcare practices commit Medicare fraud, the effects trickle down to individuals trying to receive care. Fraudulent claims cause the system to lose billions of dollars per year that are intended to pay for medical services for seniors who need them. Instead of being used to benefit hardworking Americans, that money disappears into the pockets of people who did not earn it.
Fortunately, there is something you can do about it. Speaking with an attorney could be the first step in making sure that organizations participating in Medicare fraud in L.A. face consequences.
What is a Medicare Fraud Qui Tam Lawsuit?
Qui tam lawsuits, also known as whistleblower claims or False Claims Act lawsuits, are filed by an attorney on behalf of a whistleblower and the US government. A whistleblower, or “qui tam relator,” is someone with insider knowledge or reasonable suspicion of fraud who decides to come forward so that the organization committing fraud can be investigated.
Blowing the Whistle on Medicare Fraud in L.A.
Employees are one of the greatest resources that the United States government has when it comes to exposing and stopping fraud. People may not even be aware that what they have witnessed at work is helpful or important, but it is often while performing their work duties that an employee spots something suspicious. Perhaps they notice a pattern when things are coded in the billing system, where it seems that every mistake or miscoding is one for a higher-paid service. They may begin to have suspicions of Medicare fraud but remain unsure whether they should tell anyone for fear of retaliation or being wrong.
The first step is for a whistleblower to speak with a Los Angeles Medicare fraud lawyer. You should bring any evidence you have of what you have seen or heard and share as much detail as possible about your suspicions. Tycko & Zavareei LLP will review the case and determine whether the evidence is sufficient to file a qui tam lawsuit.
After a Medicare fraud qui tam lawsuit is filed, the government must decide whether to investigate the claim. The whistleblower is given anonymity under the False Claims Act during the government’s investigation in order to protect them from illegal retaliation. As a reward for coming forward, the whistleblower may be entitled to 15-30 percent of what the government receives in the settlement, should their disclosure lead to a successful lawsuit.
Contact a Medicare Fraud Lawyer in Los Angeles
If you suspect Medicare fraud in Los Angeles, the lawyers of Tycko & Zavareei LLP are here to help. Our years of experience fighting for our clients’ rights, privacy, and settlements make us a top Medicare fraud law firm in Los Angeles. Contact us today to set up a free consultation.
