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Healthcare Fraud Attorneys

Posted On behalf of Pfeifer Morgan & Stesiak on Aug 31, 2021 in Consumer Protection

red card with medicare fraud written on itAre you aware of healthcare fraud and want to put a stop to it?

The False Claims Act gives people like you the protection you need to stop employers and other entities from defrauding the government. However, False Claims Act cases are complex, and you could greatly benefit from hiring a healthcare fraud lawyer.

Contact Pfeifer Morgan & Stesiak to learn more about how one of our licensed attorneys may be able to assist you. An initial consultation is free and comes with no obligation to hire our firm. We understand you are putting a lot on the line by stepping forward, which is why we are committed to building a strong case to pursue a favorable result.

Learn more by contacting us today. Call (844) 678-1800.

Benefits of Contacting a Healthcare Fraud Lawyer

How much do you know about the False Claims Act? How much do you understand about the process of filing a claim?

If you do not know the answers to these or other questions, that is okay. Many whistleblowers do not, and they are still able to file claims with help from an attorney.

If you have a valid claim, our firm is prepared to investigate and begin building a strong case against the party or parties that engaged in healthcare fraud. Our goal is to build a case to encourage the government to intervene, as cases with government intervention are often much more successful than those without.

With an attorney managing your case, you will simply need to provide information to help him or her build a case. We will keep you informed throughout the process, so you know what to expect.

We also know how important confidentiality is to whistleblowers, which is why we are committed to keeping things confidential until other parties must be notified.

Schedule your free consultation today. Call us at (844) 678-1800.

Examples of Health Care Fraud

In 2019 alone, the Department of Justice recovered $2.6 billion from False Claims Act cases involving healthcare. Federal authorities would not be able to secure that amount of money without help from whistleblowers who decide to come forward. 

Whistleblowers can help put a stop to many types of healthcare fraud, such as:

Billing for Services That Were Never Provided

This refers to billing a government health care program, like Medicare, Medicaid or Tricare, for services that were never provided. For example, a health care provider would be committing fraud by billing a government insurance program for testing, medical devices, drugs or other services the patient did not receive.

Billing Twice for the Same Service

Health care providers may bill a government insurance program twice for a service that was only provided one time. This allows them to double the amount of money they make from one service.

Making False Statements to Obtain Payment for Services

In 2019, Encompass Health Corporation paid $48 million to resolve claims that some of its inpatient rehabilitation facilities provided inaccurate information to Medicare. Their goal was to maintain their status as inpatient rehabilitation facilities and earn a higher reimbursement rate.

When healthcare providers make false or misleading statements with the goal of securing money, or continuing to receive money, from a government insurance program, they may have committed health care fraud.

Seeking Payment for Services Provided to a Ghost Patient

It is against federal law to submit a claim for services provided to a patient who does not exist. These patients could be referred to as ghost patients.

Providing Kickbacks to Induce or Reward the Referral of Patients or Healthcare Services

It is against federal law to make an offer, payment or solicitation to induce or reward the referral of patients or healthcare services paid for by a government healthcare program. Improper payments could include the following:

  • Referral fees
  • Finder’s fees
  • Excessive compensation
  • Discounted equipment rentals
  • Discounted leases
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  • Productivity bonuses
  • Research grants
  • Speaker’s fees
  • Free or discounted travel or entertainment

In 2019, Avanir Pharmaceuticals paid more than $95 million to resolve claims it paid kickbacks to induce healthcare providers into prescribing the drug Neudexta to treat dementia patients, even though this is not an approved use of this drug.

Insys Therapeutics also paid $195 to resolve claims it paid kickbacks to induce doctors and nurse practitioners to prescribe Subsys for patients. Subsys is an opioid and this settlement was one of the largest paid out by opioid manufacturers.

Charging More When a Service Costs Less

This type of violation often involves up-coding – changing the billing code to one that is associated with a more expensive procedure or treatment than what was performed. While it can happen due to an oversight or error, it is sometimes intentional and represents a violation of the False Claims Act.

Unbundling Procedures and Tests

Medicare and Medicaid have special reimbursement rates for groups of procedures that are often done together. However, some healthcare providers unbundle these procedures and bill for each one separately to get more money. This could be a violation of federal law.

Submitting Claims for Unnecessary Services

The law requires healthcare providers to prove treatments they recommend are medically necessary. Unfortunately, some providers bill for services that are not medically necessary.

Inflating Cost Reports

Medicare typically provides reimbursement for some overhead costs. Hospitals must file reports that itemize these expenses, along with revenue, profits and charge-to-cost ratios. However, some providers falsify these reports by inflating costs to seek higher reimbursement rates.

If you are aware of these or other types of healthcare fraud, you may be able to help put a stop to it. When healthcare fraud is allowed to continue, unchecked, medical costs may increase and impact both providers and patients.

Call our healthcare fraud attorneys today to see how we may be able to assist you.

Pfeifer Morgan & Stesiak. Call (844) 678-1800.

Compensation That May be Available in a Whistleblower Lawsuit

If the government decides to join your case, you may be eligible to receive between 15 and 25 percent of the recovered funds. If the government does not intervene, you may be eligible to receive 25 to 30 percent of the funds recovered. You may also be able to obtain compensation for attorney fees and other expenses.

Some compensation may not be monetary. For example, if you are retaliated against by your employer, you may be eligible for relief, such as reinstatement to your previous position or a promotion. You may also be eligible for backpay.

Confidentiality During a Whistleblower Claim

Whistleblowers may be concerned about stepping forward because they do not want the fraudsters, who are often the whistleblower’s employer, to find out and potentially retaliate. Even though firing you for exercising your rights is against the law, it may happen.

Fortunately, whistleblower complaints must be filed under seal – which means it is kept private. While not permanent, the complaint is filed under seal for 60 days while the claim is investigated by the government. The seal could also be extended.

This means there is no risk in talking to a consumer protection lawyer about your claim. If he or she thinks it is valid, and you decide to file a complaint, it will be kept private for at least 60 days. After that, the government will tell you if it wants to get involved.

Call Pfeifer Morgan & Stesiak to Discuss Your Claim for Free

We recommend speaking to a licensed attorney, even if you are unsure if you have a valid case. One of our healthcare fraud lawyers can answer your questions in a free consultation with no obligation to hire our firm if we validate your case.

Even though federal law protects whistleblowers, filing a claim can be complicated and the process can be very stressful. By hiring a lawyer, you can rely on him or her to manage the process, giving you peace of mind.

Call today: (844) 678-1800