Above all else, the government expects all contractors to deal honestly with the government. This is especially true for contractors who provide care to patients who are beneficiaries of government-funded programs like Medicare and Medicaid. Health care providers who submit False Certification of compliance with the rules and regulations to obtain payment for this care may be engaged in fraud.
Unfortunately, Medicare fraud is an epidemic in our country. Billions of dollars are stolen from government-funded health care programs each year from providers who bill for health care services to the programs’ beneficiaries that are in violation of laws designed to protect both the patients and the healthcare programs themselves. These laws include the False Claims Act, the Anti-Kickback Statute and the Physician Self-Referral Act (STARK).
Medicaid and Medicare pay for patient care. Fraud may occur if a healthcare provider charges for services not rendered. It can also occur if a healthcare provider performs tests or procedures that lack medical necessity.
Fraud can also happen that has nothing to do with the care that the actual patient receives. In many cases, the fraudulent scheme involves manipulation of the payment systems in place to reimburse a healthcare provider for services to Medicare and Medicaid (or in Georgia, PeachCare) beneficiaries. This includes Upcoding (claiming that the patient received a more expensive procedure or test than was actually administered to increase reimbursement from the government). Medicare fraud involving billing also happens when a provider includes false information in the reports it must provide to the government.
In our experience, there are an infinite number of potential fraudulent schemes that can occur. In fighting these frauds, the government will need whistleblowers with inside information about the health care providers exposing the newest trends in fraud on the government. If you believe someone has engaged in Medicare fraud and you would like to learn more about or would like to bring a whistleblower lawsuit, Mike Brown can help you. He understands qui tam litigation, including the whistleblower protection provisions, and is relentless in the pursuit of best possible outcomes for each client.
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