Hospital Fraud and Medical Practice Fraud

Health care whistleblowers have assisted the federal government fight hospital fraud by filing qui tam lawsuits under the federal False Claims Act. In some cases, these health care whistleblowers have alleged that hospitals defrauded government health care programs such as Medicare Part A and Medicaid, which pay for hospital services for eligible beneficiaries.

In addition, health care whistleblowers have filed qui tam lawsuits under the federal False Claims Act alleging medical practice fraud. Indeed, Lawsuits by health care whistleblowers have been used to combat Medicaid and Medicare fraud by medical practices.

Some of the ways health care whistleblowers have alleged hospital fraud and medical practices fraud under the federal False Claims Act include:

  1. Billing for Services Not Rendered: Billing the federal government for services never provided to the patient.
  2. Billing for Unnecessary and/or Unreasonable Services: This involving billing for services that were actually provided, however, the patient did not need the service provided.
  3. Upcoding: All services reimbursed by the federal government are assigned codes which determine how much the provider will be reimbursed. Physicians and hospitals commit fraud on the federal government when they knowingly bill for a code that provides a higher reimbursement. This would be a fraudulent claim submitted to federal government health care programs.
  4. Anti-Kickback Statute Violations: Kickbacks do not have to be money. Rather, they include anything of value provided in exchange for referrals from the receiving party. This violates the federal Anti-Kickback Statute. Medicare will not reimburse claims tainted by kickbacks and therefore submitting such claims for payment to the federal government violates the False Claims Act.
  5. Stark Law Violations: Under certain circumstances, the Stark Law makes it is illegal for a physician to refer government health care beneficiaries for “designated health services” reimbursed by federal health care programs to a business which he or she (or family member) has an ownership interest.

Hospitals have also defrauded federal government health care programs by engaging in fraudulent cost reporting. Hospitals are reimbursed by federal health care programs such as Medicare, in part, based upon how much it costs to operate the hospital. If a hospital knowingly inflates its cost report to receive extra money, this violates the federal False Claims Act.

No Fees Without Recovery

Ross M. Wolfe and the Weiser Law Firm litigate whistleblower lawsuits on a contingent fee basis, so whistleblowers do not pay attorneys’ fees or court costs unless there is a recovery.

Please contact Ross M. Wolfe if you would like to speak with a whistleblower attorney for more information about the whistleblower process, health care whistleblowers, hospital fraud, medical practice fraud or to schedule a free confidential consultation to discuss your potential case.