Healthcare fraud is an epidemic — and a costly one, at that. Medical providers, private practices, and large health systems engage in healthcare fraud when they submit inaccurate patient information to insurance companies for financial gain.

Healthcare fraud can include medical billing malpractice, double billing, and misrepresenting procedures to obtain payment for non-covered services. Unfortunately, these fraudulent practices happen behind the scenes of providers we know and trust, often at the expense of patients and taxpayers in California.

Tycko & Zavareei LLP is a national law firm that holds health systems all over the country accountable for healthcare fraud. There is protection and possible financial rewards available for medical staff or workers who come forward with evidence of waste, fraud, or abuse. Only whistleblowers can help put a stop to fraud and protect the vulnerable people of San Jose, CA.

If you suspect that your employer or another member of your organization is committing fraud, speak with a San Jose healthcare fraud lawyer in confidence regarding a possible qui tam lawsuit. Our qui tam attorneys can help you understand whether you have a viable claim and how to proceed with becoming a whistleblower.

Common Types of Healthcare Fraud in San Jose, CA

Providers that lie to insurers or the government for monetary gain cause billions of dollars in losses that result in higher medical costs and insurance premiums for patients. Healthcare fraud is an abuse of power, wasteful, and damaging to the California and national economies.

Different types of healthcare fraud disguised as everyday business practices often go unnoticed. Examples of healthcare fraud include:

• Upcoding: One of the most common methods of defrauding the government, upcoding involves billing for services that were never actually rendered or billing a patient for a more expensive service than what was actually provided to them. Unless a patient catches the mistake, a provider can make “easy” funds this way from Medicaid and Medicare.
• Unbundling: Unbundling is a similar practice to upcoding, as medical services are often “bundled together” when reporting to Medicare or Medicaid. Bundled services often give the patient a discounted rate. To work around this, providers might separate the services and bill for them individually to charge more.
• Kickback arrangements: Doctors who accept money in exchange for a patient referral or when referring patients to another facility are part of a “kickback scheme.” Kickbacks are common and often occur “under the table.” Physicians should be recommending patients to specialists and facilities based on their medical needs, not based on a financial interest between unscrupulous healthcare entities.
• Billing for medically unnecessary services: Also known as “phantom billing,” a healthcare provider might misdiagnose a patient and order tests and procedures that are not medically necessary. This puts patients at risk of harm and costs them money they do not need to spend.
• Charging personal expenses to Medicaid: Some corrupt healthcare organizations charge personal expenses to Medicare. This is often more prevalent in nursing homes. As nursing homes are reimbursed based on the annual submission of a cost report, a provider or another healthcare worker can charge the cost of their personal car or home on the report.

Medical transportation companies, healthcare systems, medical laboratories, and equipment companies can be responsible for inflating bills, double billing, and overcharging for their services. If you have witnessed misconduct and believe fraud is at play, the lawyers of Tycko & Zavareei LLP are experienced in whistleblower claims and can offer immediate legal support and counsel regarding a qui tam claim.

Why is Healthcare Fraud a Big Deal?

Healthcare fraud takes advantage of people and hurts the economy, as it causes significant losses and waste. It exposes patients to unnecessary medical treatments, higher insurance premiums, and taxes, among other things. Fraud and abuse in our healthcare system are too big to ignore—Medicare fraud costs Americans $60 billion yearly, according to the United States Senate Committee on Finance.

With the help of a whistleblower, a qui tam attorney can make real change and prevent more people from experiencing the pain of fraud. An example of this is a recent settlement against Northern California-based Sutter Health. When allegations surfaced regarding misconduct, the health giant agreed to a $13 million settlement for billing government health programs for lab tests performed by others.

Am I Protected if I Report Fraud and File a Whistleblower Lawsuit?

San Jose workers who report healthcare fraud are known as “whistleblowers.” Whistleblowers have the right to file a qui tam lawsuit against an employer that has engaged in healthcare fraud, whether it is kickback schemes, overbilling, false billing, or any other form of waste or abuse. If you are unsure about whether your employer has engaged in healthcare fraud, contact our firm for a free legal consultation.

The first step in the whistleblower journey is often the hardest. Reporting your employer without fully understanding the consequences is a challenging decision to make, and a brave one at that. With a qui tam lawsuit, we ensure whistleblowers remain completely anonymous under the California False Claims Act (CFCA) and federal False Claims Act until the government completes its investigation and finds evidence of fraud. Any signs of healthcare fraud or information that could lead to the recovery of significant funds can result in a substantial financial reward for you.

Choose a qui tam law firm experienced in healthcare fraud to protect your identity, avoid employer retaliation, and make a significant difference in San Jose. Tycko & Zavareei LLP will investigate your report, and if your discovery results in defrauded funds, you may be entitled to a reward under the California False Claims Act or federal False Claims Act. These laws also protect whistleblowers in San Jose from workplace retaliation after reporting a violation. In addition to a qui tam lawsuit, we can advise you on filing a lawsuit to hold your employer accountable for retaliating against you.

Why Hire Tycko & Zavareei LLP?

We have represented courageous whistleblowers in cases nationwide that resulted in significant settlements. Take our case against a National Home Healthcare provider as an example. We represented two directors of nursing in a False Claims Act qui tam case as the home health agency they worked for was receiving Medicare dollars for patients that were not actually provided or even medically necessary. Doctors also were receiving kickbacks for patient referrals. A verdict was reached, the home health company owed $2.1 million to the government, and our clients received a 17 percent reward for reporting their employer.

Both the federal and California False Claims Acts help protect San Jose healthcare fraud whistleblowers from employer retaliation, such as harassment, demotion, threats, suspensions, or other unlawful employment actions.

Act Now and Fight Fraud: Speak with a San Jose Healthcare Fraud Attorney

Tycko & Zavareei LLP is a firm with creative and top legal talent specializing in complex and confidential whistleblower cases involving healthcare, government contract, and other types of fraud. We are committed to representing brave whistleblowers and preventing more fraud and other business practices that hurt the people of San Jose, CA.

Take the first step today and schedule a free case evaluation with an experienced San Jose healthcare fraud lawyer today.