Nevada Healthcare Fraud Whistleblower Lawyer

Nevada Healthcare Fraud Whistleblower Lawyer

Each year, Medicare and Medicaid fraud cost Arizona taxpayers billions of dollars. The FBI estimates that nationally, healthcare fraud costs taxpayers $80 billion every year. While most healthcare providers work ethically and adhere to the laws, there are some that do not.

Healthcare employees that uncover and report fraud at work are called whistleblowers. There are federal and state laws in place that encourage whistleblowers to come forward by protecting them from retaliation and offering a financial incentive if funds are recovered. If you are a healthcare worker aware of fraud within the healthcare industry or have been retaliated against for reporting it, contact the Nevada healthcare fraud whistleblower lawyers at Tycko & Zavareei LLP, one of the top whistleblower law firms in the country, for a confidential legal consultation.

Types of Healthcare Fraud in Nevada

Healthcare fraud is a widespread problem in America, with fraudulent claims accounting for as much as 10% of nationwide healthcare expenses. In just 2020 alone, the Department of Health and Human Services reported over $6 billion in losses to federal healthcare programs. Healthcare fraud occurs in hospitals, private practices, surgical centers, rehabilitation centers, drug treatment centers, and other types of medical facilities.

Healthcare fraud can include:

• Misrepresenting Medicaid and Medicare claims
• Performing unnecessary medical procedures to increase billing rates
• Changing patient records
• Misleading representation of a healthcare provider’s qualifications
• Accepting kickbacks for referring patients or for prescribing a particular drug or medical device
• Misleading claims by a pharmaceutical company or medical device manufacturer

What is Medicare Fraud?

Established by federal statutes and regulations from the HHS, Medicare is a federal system of healthcare cost reimbursement for certain healthcare expenses for Americans 65 years of age or older. There are several different types of Medicare fraud:

• Medicare Part A fraud: Medicare part A payments are made to providers like hospitals, home health agencies, and skilled nursing facilities. Violations may include diagnosis-related group upcoding, one-day stay violations, and billing for procedures that are not medically necessary.
• Medicare Part B fraud: Medicare part B services are provided by doctors, suppliers, and other healthcare professionals and are usually paid on a Medicare schedule. Violations may include billing for services that were not ordered or rendered, misrepresenting services that have been rendered, billing for services that are medically unnecessary, falsifying records in order to meet conditions, and more.
• Medicare Part C fraud: Medicare participants have the option to select a managed care plan that is certified under Medicare. Medicare makes payments to the managed care plan in place of the payments they would have made under traditional Medicare. Violations include inflating general and administrative costs, intentionally failing to pay providers or provide necessary and reasonable services to Medicare patients, Managed Care Organization (MCO), and provider relationships that are driven by cost containment at the patient’s expense.
• Medicare Part D fraud: Medicare part D plan beneficiaries receive access to Medicare drug benefits through private plans that have been approved by the Centers for Medicare & Medicaid Services (CMS). Violations may include falsifying documents or claims for non-covered drugs, failing to apply the “maximum allowable cost” pricing to medications, submitting claims and false documents for brand name drugs when generics were given, unlawful kickbacks, and more.

What is Medicare Advantage Fraud?

Medicare Advantage (MA) plans are healthcare options that are privately run and offer individuals that are eligible for Medicare additional services that are not normally included with Medicare. The organization collects Medicare payments for each member that vary by risk adjustment, and some MA organizations overexaggerate and overestimate members’ risks and diagnoses in order to get higher payments from Medicare. The ways in which MA organizations may defraud Medicare include:

• Using outside vendors to allow for unsupported diagnoses: MA organizations may hire outside vendors to conduct chart audits who agree to ignore unsupported diagnoses on a patient’s chart.
• Chart mining: This involves MA organization employees mining patients’ charts to look for conditions that are not current but that they can list as current to increase the amount of money received in payments from Medicare.
• Upcoding: This is where a MA organization submits a more serious diagnostic code in order to increase the severity of the patient’s condition and increase the payment rate from Medicare.
• Pre-filling chart: MA organization coders are told to pre-fill a patient’s chart with other information.

What is Medicaid Fraud?

Designed to provide healthcare for low-income Americans, Medicaid is a federal-state program that directly reimburses healthcare providers for any services rendered to beneficiaries. Medicare fraud can include:

• Billing for services that have not been rendered
• Misrepresenting services that were rendered
• Duplicate billing and split billing
• Increasing units of service
• Providing kickbacks unlawfully

How Can Nevada Whistleblowers Expose Healthcare Fraud?

Since the government has limited means of enforcing anti-fraud protection, whistleblowers are given the power to bring whistleblower lawsuits against fraudulent healthcare providers under the False Claims Act (FCA). The FCA gives whistleblowers incentives to come forward with proof of fraud by rewarding them with a percentage of stolen funds that are recovered by the government.

If you have proof of Medicare, Medicaid, TRICARE, Veterans, VA, or similar healthcare fraud taking place, it may be in your best interest to contact a qualified healthcare fraud whistleblower law firm that can explain the legal process and guide you through the steps of filing a whistleblower lawsuit.

Contact a Nevada Healthcare Fraud Whistleblower Lawyer

At Tycko & Zavareei LLP, our whistleblower lawyers are nationally recognized in the field of whistleblower law and have helped hundreds of whistleblowers shed light on fraudulent healthcare providers. If you have proof of healthcare fraud and are considering taking legal action, contact the Nevada healthcare fraud whistleblower lawyers of Tycko & Zavareei LLP. During a confidential legal consultation, our whistleblower lawyers will thoroughly evaluate your case and help you understand your options.