Every year, millions of Americans get their healthcare via the federal government. The Medicaid program provides healthcare benefits to those whose income falls under a certain amount. Healthcare providers are responsible for putting in claims to Medicaid and collecting benefits for the services that they provide to their patients.
But what happens when those providers take advantage of the system? That is where whistleblowers come in. Speaking up about healthcare fraud is not easy, but it is necessary to keep the healthcare system running as smoothly and fairly as possible. If you have knowledge of DC Medicaid fraud, schedule a free and confidential consultation with one of our whistleblower attorneys.
Medicaid in the United States
Medicaid was established in 1965 as a way to provide healthcare to those who might otherwise not be able to afford it, while its partner program, Medicare, provides healthcare to people over the age of 65. It works similarly to a private insurance company, except qualified medical services are covered by funds from the government rather than a private company. As of September 2021, nearly 78 million Americans are enrolled in Medicaid.
Medicaid Fraud: Overview and Types
Medicaid fraud happens when a healthcare provider, such as a doctor, practice, or hospital, deliberately deceives the government in order to receive funds or benefits to which they have no legitimate claim. Here are a few common types of fraud against the Medicaid system.
False Billing
False billing can occur in many different ways, but the basic premise is the same: purposefully misrepresenting information when billing Medicaid in order to get a bigger payout. Some examples of false billing include:
- Billing for services that were never performed.
- Intentionally coding items incorrectly when billing Medicaid so that they are coded as more expensive services. This practice is known as “upcoding.”
- Billing twice for the same service.
Kickbacks
Kickbacks are a form of bribery in which a physician takes a payment or gift in exchange for prescribing a certain medication and then billing Medicaid for it. Usually, these medications are more expensive than their alternatives and in some cases, they may not even be the most appropriate treatment for the patient.
Ordering Unnecessary Services
A doctor or healthcare practice may try to get patients to undergo unnecessary medical services in order to bill Medicaid for more money. These services may include lab tests, unnecessary follow-ups for conditions that are past the need for monitoring, and even surgeries or procedures.
Common Signs of Medicaid Fraud
In order to know whether you should speak up about DC Medicaid fraud that you witness at work, it is important to know the signs that it may be happening. Here are a few red flags that indicate possible fraud:
- Things are consistently coded incorrectly when billing, usually for higher amounts than they should be.
- You notice tests being ordered or procedures being recommended that do not seem to be in the patients’ best interests.
- A certain medication or brand is prescribed more than others, even though there are less expensive options available.
The Role of a DC Medicaid Fraud Whistleblower
A whistleblower is someone who sees illegal and fraudulent activity and chooses to speak up. They should have reason to believe that the provider they are reporting should be investigated and evidence to support that.
During a confidential consultation with Tycko & Zavareei LLP, our DC Medicaid fraud whistleblower attorneys can answer any questions you may have about coming forward. The consultation comes at no cost to you until and unless your case is accepted and successfully resolved, and you will not lose anything if it turns out that your case is not strong enough to pursue.
DC Whistleblower Protections Under the False Claims Act
The False Claims Act, passed in 1863, made it a federal offense to knowingly file a false claim for government benefits. Today, the False Claims Act makes it possible for everyday citizens to alert the government and law enforcement to fraud, corruption, and abuse and stay safe from retaliation.
Federal law makes it illegal to retaliate against someone for blowing the whistle on fraud. In the workplace, retaliation can take the form of a demotion, a transfer, or even termination. The possibility of retaliation is yet another reason that you should have a lawyer working with you. Calling a DC whistleblower law firm should be your first step when you decide to blow the whistle on Medicaid fraud.
Making a Protected Disclosure Under the False Claims Act
How does one make a protected disclosure about Medicaid fraud? First, you will need to speak with a False Claims Act lawyer in your area and set up a consultation. During the consultation, you will discuss your case with the lawyer and show them any evidence of fraud that you may have. If your lawyer determines that there is enough evidence to make a solid case, they can then help you file a whistleblower complaint.
Once you file a complaint through your lawyer, the government may start an investigation. You will communicate through your attorney in order to retain your anonymity, but if your disclosure leads to a successful lawsuit, you may be entitled to a portion of the lawsuit settlement. Whistleblowers typically receive between 15-30% of what the government may collect from a qui tam lawsuit.
If you are ready to come forward about Medicare fraud, contact Tycko & Zavareei LLP today for a free consultation.
