CHIP Healthcare Fraud in North and South Carolina: What You Can Do & How to Report It

Healthcare fraud undermines the integrity of the Children’s Health Insurance Program (CHIP). It robs taxpayers and ultimately harms the most vulnerable members of our community – children who need essential medical services. As a potential whistleblower, you play a crucial role in helping protect these vital healthcare resources and holding fraudulent actors accountable.

If you know of or suspect CHIP fraud, call 1-888-292-8852 or contact us online now for a free, confidential conversation with a professional.

What are some common types of CHIP fraud?

Some common examples of Children’s Health Insurance Program (CHIP) fraud you could witness may include:

1. Billing for services never provided to patients

• Submitting claims for preventive dental services (e.g., cleanings, fluoride treatments) that were never performed on CHIP-eligible children
• Charging for well-child visits or developmental screenings that didn’t actually occur
• Billing for vaccinations that were not administered to CHIP beneficiaries

2. Using improper codes to charge for higher-priced services

• Upcoding a basic pediatric office visit to a comprehensive exam
• Misrepresenting a routine vision screening as a more complex ophthalmological examination
• Coding for a higher level of speech therapy than what was actually provided to a CHIP-enrolled child

3. Submitting claims for non-covered services by misrepresenting them as covered

• Billing cosmetic dental procedures (e.g., teeth whitening) as medically necessary treatments
• Charging for experimental treatments or therapies not approved for CHIP coverage as standard medical care
• Submitting claims for non-medical equipment as durable medical equipment covered by CHIP

4. Falsifying medical records or supporting documentation

• Creating false growth charts or developmental assessments to justify unnecessary treatments or specialist referrals
• Altering dates of service to circumvent CHIP’s coverage limitations or frequency restrictions
• Fabricating symptoms or diagnoses in patient records to support claims for services not medically necessary

5. Receiving kickbacks for patient referrals

• Accepting payments for referring CHIP beneficiaries to specific specialists or facilities, regardless of medical necessity
• Offering incentives to schools or community organizations for directing CHIP-eligible families to particular providers
• Providing or accepting compensation for enrolling children in CHIP when they are not eligible

6. Dispensing medications without valid prescriptions

• Filling prescriptions for CHIP beneficiaries without proper authorization from a licensed healthcare provider
• Dispensing brand-name drugs when generics are prescribed and billing CHIP for the more expensive medication
• Providing over-the-counter medications to CHIP patients but billing as if they were prescription drugs

These and other fraudulent practices not only drain critical resources from the healthcare system but also compromise the quality of care for children who depend on CHIP for their medical needs. If you suspect fraud against CHIP, you could help stop it – and possibly receive a large reward.

How can I report suspected CHIP fraud?

Navigating the complex world of healthcare fraud reporting can feel overwhelming and intimidating. A whistleblower attorney who has handled other whistleblower cases can be your guide through the process and help protect your best interests.

Government hotlines often leave potential whistleblowers feeling isolated and uncertain, wondering if their crucial information will ever be seen or acted upon. Worse, by reporting fraud through a government hotline, you may jeopardize your chance for a life-changing reward through the False Claims Act.?

By working with a dedicated whistleblower attorney, you transform a potentially scary experience into a structured, supportive process in which you can help put a stop to fraud and pursue a whistleblower reward with confidence.

Why choose Carolina Whistleblower Attorneys?

Our team has the experience, knowledge, and track record to take on any whistleblower case for you. We are led by former U.S. Attorney Bill Nettles, who was appointed by the White House specifically to help curb fraud against the government.