Medical Equipment Fraud Whistleblower | Medical Testing Fraud Whistleblower
Whistleblower Lawsuit, Whistleblower Act, Whistleblower Protection, Whistleblower Law | Medical Equipment Fraud Whistleblower, Medical Testing Fraud Whistleblower | Fraud Whistleblower Lawyer, Attorney, Lawsuits
Healthcare fraud costs Medicare, Medicaid and other health insurance programs billions of dollars every year. The False Claims Act seeks to encourage honest individuals to become whistleblowers and report fraudulent practices on the part of healthcare providers. Common forms of healthcare fraud that fall under whistleblower provisions of the False Claims act include medical equipment scams and fraudulent medical testing. If you can provide evidence of such fraud, you may be eligible to file a whistleblower lawsuit on behalf of the U.S. government.
The largest recoveries in healthcare fraud whistleblower lawsuits have exceeded $100 million. Healthcare fraud whistleblowers who report medical equipment fraud and medical testing fraud can collect between 15 and 25 percent of the federal government’s recovery in a successful whistleblower lawsuit. The whistleblower provisions of the False Claims act also protect healthcare fraud whistleblowers from retaliation by their employers.
Medical Equipment Fraud
Durable medical equipment, such as medical supplies and home care products, continues to be a significant source of fraud affecting insurers, government agencies, and patients who rely upon this equipment for their ongoing health needs. Examples of durable medical equipment include wheelchairs, prosthetic devices, portable oxygen tanks, orthotics, and implants. For these types of products to be covered under Medicare and Medicaid, a physician must order medical equipment through a “Certificate of Medical Necessity” (CMN) which is sent to a supplier who fills the order. The supplier can then file a claim with Medicare or Medicaid.
Fraud that involves the durable medical equipment may include:
- Billing for equipment or supplies that were never provided.
- Billing for products that were no longer medically necessary or were not ordered by the treating physician.
- Upcoding, which occurs when a health care provider submits a claim for an item of durable medical equipment with an improper
- Kickbacks from suppliers to physicians for referrals.
- Submitting claims for nonexistent patients by using borrowed social security numbers.
- Charging Medicare or Medicaid for devices that have not been approved by the U.S. Food and Drug Administration.
billing code, so as to obtain more money than is allowed by law.
Medical Testing Fraud
Medical testing provides numerous opportunities for healthcare fraud. One of the most common fraudulent medical testing scams involves billing for a doctor’s time when the physician was not actually present. For example, a medical testing facility might claim a doctor performed lab tests when it makes submissions for Medicaid or Medicare reimbursements. In realty, no physician was present at all, and the work was actually done by a lab technician.
Other types of medical testing fraud may include:
- Unbundling: Medicare and Medicaid often have special reimbursement rates for groups of tests commonly done together, such as typical blood test panels by clinical laboratories. Some health care providers seeking to increase profits will “unbundle” the tests and bill separately for each component, which totals more than the special reimbursement rates.
- Kickbacks for referrals: This can involve payment of a percentage of the reimbursement for every patient a physician refers to a testing facility.
- Billing for tests that are not medically necessary.
- Billing for tests that were never performed.
Learn More about Reporting Medical Equipment Fraud and Medical Testing Fraud
If you want to become a healthcare fraud whistleblower, and have first-hand knowledge of medical equipment and medical testing scams, Alonso Krangle, LLP can help. We offer free legal evaluations to potential False Claims Act whistleblowers. Our whistleblower lawyers will review your case in detail, and ensure you comply with the detailed requirements of the False Claims Act. For more information, please fill out our online form or call 1-800-403-6191 today.