Reporting Medicaid and Medicare Billing Fraud in North & South Carolina
Whistleblowers help expose billing scams against the government – and can receive a reward!
Whistleblowers play a vital role in protecting the integrity of government healthcare programs by helping to uncover Medicaid and Medicare billing fraud that costs taxpayers billions of dollars each year. By coming forward with evidence of wrongdoing and false claims related to Medicare and Medicaid billing — such as phantom billing, upcoding, unbundling, and overbilling of services and prescriptions — whistleblowers help safeguard these essential programs from healthcare fraud.
Under the False Claims Act, individuals who expose fraud may, not only help stop unethical practices, but also receive financial rewards (up to 30% of any recovery) for their efforts. Do you suspect fraud? At Carolina Whistleblower Attorneys, we’re experienced in pursuing whistleblower claims in North and South Carolina for Medicare and Medicaid waste and abuse.
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.
Understanding Medicare and Medicaid phantom billing fraud
Understanding Medicare and Medicaid Phantom billing fraud involves submitting claims to Medicaid or Medicare for services, procedures, or equipment that were never provided or delivered to the patient. For instance, a provider may bill for a test that was not performed or may bill for an office visit that never occurred.
What is upcoding healthcare fraud in Medicare or Medicaid?
What is Upcoding involves billing Medicare or Medicaid for a more expensive service or procedure than what was actually provided. For example, a provider might perform a simple follow-up office visit but bill it as a more complex consultation.
Unbundling scams in Medicare and Medicaid healthcare
Unbundling occurs when healthcare providers separate components of a single procedure and bill them individually to maximize reimbursement from Medicare or Medicaid, even though they should be billed as one bundled service. A common example of unbundling is when a provider bills separately for incisions and closures during surgery.
Types of Medicare and Medicaid overbilling of services
Types of Medicare and Medicaid Overbilling of Medicare and Medicaid services scams involve healthcare providers intentionally inflating charges, misrepresenting services, or billing for services that were not necessary or never provided. For example, if a clinic bills for a physical therapy session even though the patient never attended the appointment.
Overbilling of Medicare and Medicaid prescriptions is fraud
Overbilling of Medicare and Medicaid prescriptions is fraudHealthcare providers or pharmacies may inflate costs, prescribe unnecessary medications, or overstate the quantity of drugs provided to receive additional reimbursement. Other examples of this type of prescription ovebilling fraud include overbilling for brand name drugs instead of generics or billing for drugs not dispensed.
Other types of Medicare and Medicaid billing fraud to be aware of
Unfortunately, there are many other Medicaid and Medicare waste and abuse schemes in which healthcare providers, suppliers, and pharmacies try to scam the government. Other ways fraudsters inflate costs or falsify claims to receive higher-than-deserved Medicare or Medicaid reimbursements include:
- Double billing for the same service, procedure, or medication
- Misrepresenting non-covered services to make them appear reimbursable
- Falsifying patient diagnoses to justify costly procedures or treatment not medically necessary
- Billing for unnecessary tests, procedures, or services
- Billing for non-covered services hoping the government pays without noticing
- Billing for services provided due to illegal kickbacks or bribes
- Submitting claims for deceased patients
How Carolina Whistleblower Attorneys can help you fight Medicare and Medicaid billing fraud
If you suspect Medicare or Medicaid billing fraud and are considering exposing it, it’s important to have an experienced guide to help you through the whistleblower process. Our whistleblower team is led by former U.S. Attorney Bill Nettles. During his tenure, Bill led South Carolina to become 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 all types of medical billing fraud involving Medicare and Medicaid. 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, we put your interests first every step of the way.
Whistleblowers can play a critical role in identifying overbilling schemes. If you suspect any type of Medicaid or Medicare 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.
Contact us online or call 1-888-292-8852 today!
Awards we’ve won
