Do you suspect phantom billing or medical upcoding by a healthcare provider?

Medical billing fraud leads to increased healthcare costs and reduced quality of care for patients in North and South Carolina, as well as higher taxes. If you suspect medical billing fraud, you can fight back by filing a whistleblower claim – and possibly receive a life changing reward.

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Phantom Billing, Medical Billing Fraud, and Medical Upcoding: Healthcare Fraud Against the Government

Healthcare fraud hurts patients and costs taxpayers billions of dollars every year. One of its most insidious forms is medical billing fraud, in which government insurance programs are charged for more expensive services than the patient really received.

If the thought of healthcare providers and others taking advantage of vulnerable medical patients for financial gain makes you mad, you’re not alone and you’re not powerless. You can fight medical billing fraud by filing a claim under the federal False Claims Act (FCA) to try to hold fraudsters accountable – and you could receive up to 30% of any recovery as a reward.

At Carolina Whistleblower Attorneys, we’re experienced in pursuing whistleblower claims in North and South Carolina for medical upcoding, phantom billing, and other forms of healthcare fraud. Contact us today at 1-888-292-8852 for a free, confidential discussion that can give you peace of mind and help you decide how you want to proceed.

Common types of medical billing fraud

Common types of medical billing fraud include:

Phantom billing: Billing for services, procedures, or tests that were never provided
Upcoding: Charging for a more expensive service than was performed
Unbundling: Separating services that should be billed together, resulting in higher charges
Billing for unnecessary services: Charging for tests or procedures that are not medically necessary
Misrepresentation of services: Providing incorrect or misleading information about services provided, such as altering patient diagnoses to justify more expensive treatments
Kickbacks and bribes: Billing for services provided through illegal kickbacks or inappropriate referral arrangements such as bribes
Billing for non-covered services: Charging for services not covered by insurance with the hope the government pays without noticing

What is phantom billing?

Phantom billing is a form of medical billing fraud where healthcare providers bill insurance companies or government programs like Medicare or Medicaid for services, tests, or procedures that were never provided to the patient. Some examples include:

Fake patients or services: Fabricating a patient visit or procedure and then billing for services that were never rendered, such as a surgery that never took place on a person who doesn’t exist
Duplicate billing: Charging multiple times for a provided service that was already paid for
Exaggeration of services: Billing for minor procedures as if they were more complex and expensive, such as billing a brief consultation as a full examination
Billing dead patients: Billing for services supposedly provided to patients who have passed away

Phantom billing is not victimless. It creates substantial burdens for vulnerable patients as well as U.S. taxpayers, including:

Extreme health risk to patients: Patients are often treated incorrectly during medical billing fraud schemes, which can worsen their conditions to the point of great suffering and death
Fewer healthcare resources at greater cost: Government programs such as Medicare and Medicaid are defrauded of limited money intended for those who really need it, leading to higher healthcare costs for everyone

How to spot medical upcoding fraud

If you’re suspicious of upcoding, look for the following key indicators:

	Excessive or unusually high patient charges
	Unusual patterns in coding or unexplained codes
	Discrepancies between bills, medical records, and insurance records
	Frequent billing of a particular code or procedure, especially if it’s high-cost
	Multiple codes for the same or similar services

If you suspect medical billing fraud, contact us online or at 1-888-292-8852 now for a free, completely confidential conversation.

How to report healthcare fraud against the government

If you suspect medical billing fraud such as phantom billing or upcoding, you can file a whistleblower claim under the False Claims Act (FCA).

Your identity will be protected while the government investigates your claim and you could receive a reward of up to 30% of the government’s recovery in a successful case.

Two of our whistleblower clients received a $5.4 million reward as part of a $22.5 million judgment against Doctors Care, P.A., one of the largest urgent care providers in South Carolina, after they came forward with allegations of medical billing fraud and phantom billing.^1,4

How a whistleblower lawyer can help if you suspect medical billing fraud

An attorney with experience handling whistleblower cases can help you by:

Evaluating the strength of your case
Helping you file a whistleblower lawsuit
Fighting for the maximum reward you may deserve
Using federal law to help protect you from retaliation. See how:

Our team is led by former U.S. Attorney Bill Nettles. During his tenure, South Carolina became one of the top four states in the nation for whistleblower recoveries.^{1, 4}

Our mission is to expose fraud against the government, and we stand with those who have the courage to report medical billing fraud, including phantom billing and upcoding. Our client success stories prove our dedication to seeking justice.^1,4

We operate on a contingency fee basis, which means we cover all the costs of building your case, and you don’t pay a penny unless we win an award for you—guaranteed.² With our You-First Policy, your interests come first every step of the way.

If you suspect medical billing fraud, let’s have a confidential conversation. We can answer your questions and help you explore your options. The consultation is free, and there’s no obligation.