Healthcare fraud impacts not only doctors and patients, but also every taxpayer who supports programs like Medicare and Medicaid. For that reason, anyone who spots signs of healthcare fraud in New Jersey should take a stand and blow the whistle.
Becoming a whistleblower can be intimidating when you consider how healthcare fraud is often executed by hospitals and healthcare companies that have a lot of power and resources. The good news is that you can level the playing field by hiring a New Jersey healthcare fraud lawyer.
Retaining an attorney could help ensure that you receive the whistleblower reward you deserve for exposing healthcare fraud in NJ. Learn everything you need to know about healthcare fraud qui tam claims below.
Have You Spotted Signs of Healthcare Fraud in NJ?
Healthcare-related qui tam lawsuits begin when someone identifies and reports potentially fraudulent actions occurring within a healthcare organization. This person might notice that a patient’s bill and services rendered do not match up, or they might notice that a doctor ordered tests for a Medicare patient that they do not really need. Either way, they believe, in good faith, that fraud is occurring. From there, the person should seek out the services of a NJ healthcare fraud attorney.
Healthcare fraud costs around $70-234 billion every year. Anyone who suspects that healthcare fraud is taking place can file a qui tam claim on behalf of the government, taxpayers, and everyone else impacted by the fraud.
Most people do not know that a whistleblower has a financial incentive to initiate a claim and expose the wrongdoing. Per the federal False Claims Act, a whistleblower can receive anywhere from 15 to 30 percent of any settlement reached in a qui tam claim. If a whistleblower reports fraud involving state-funded healthcare programs, they may also be eligible to receive an award of 15 to 30 percent of the amount recovered under the New Jersey False Claims Act (NJFCA). Depending on the nature of your claim, that could end up being a substantial reward.
Common Types of Healthcare Fraud in New Jersey
Of course, you will not be able to blow the whistle or seek out a claim if you are not able to identify what healthcare fraud is or what it looks like. Below, we’ll go over some of the most common types of healthcare fraud in NJ that could result in a qui tam case.
Excessive Billing
One of the most common types of healthcare fraud in New Jersey and elsewhere is excessive billing. This type of fraud happens when a healthcare organization overbills or excessively bills a patient for their services. This far-too-common practice also includes upcoding, which happens when a doctor uses a more expensive code to define a service that was actually rendered.
Phantom Billing
Phantom billing happens when a healthcare organization charges a customer for a service that was never rendered.
Unbundling
Unbundling happens when certain services that are usually bundled together are charged individually, or unbundled. This process usually makes a patient’s bill more expensive than it should be.
Nursing Home Fraud
Nursing home fraud happens when an organization commits a form of healthcare fraud against an unsuspecting nursing home resident.
Medicare and Medicaid Fraud
This type of healthcare fraud happens when a healthcare provider submits a falsified bill to Medicare or Medicaid in order to get paid for services that were never rendered or necessary.
According to the New Jersey Office of State Comptroller, $77 million of misspent Medicaid funds were recovered in 2020 alone.
How Does a New Jersey Whistleblower Claim Work?
If you suspect healthcare fraud is occurring, you can seek out a qui tam lawsuit. Unlike a traditional lawsuit, the plaintiff will be the US government, not the whistleblower. In other words, you will file a lawsuit on behalf of the government. Once you fill out all the proper paperwork to file a claim, an investigation will ensue. Sometimes, the government will decide to intervene in your case, but other times, they will allow the case to play out in court.
If the court determines that healthcare fraud did occur, they will order the guilty party to pay specific damages. A portion of this settlement will go to the whistleblower to reward their bravery in coming forward to report fraud.
How Can a New Jersey Healthcare Fraud Lawyer Help Me?
You will need to hire a lawyer in order to file a qui tam lawsuit against a party suspected of committing fraud. Here at Tycko & Zavareei LLP, our lawyers strive to help clients by informing them about their legal options, helping them determine whether seeking out a claim is worth it, and guiding them through all the legal steps necessary to blow the whistle successfully.
Get in Touch with a New Jersey Healthcare Fraud Attorney Today
If you believe you have compelling evidence of healthcare fraud, do not hesitate to file a qui tam lawsuit with a lawyer’s help. Not only can you help stop the fraud, but you can also help ensure that the burden of the fraud does not fall on the shoulders of New Jersey taxpayers.
Working with a New Jersey healthcare fraud lawyer may be your best option for exposing wrongdoing in the medical field. Here at Tycko & Zavareei LLP, we want to help you achieve your legal goals.
Schedule a completely confidential case evaluation with our attorneys by filling out our online form today.
