Blow the Whistle on Medicare & Medicaid Upcoding Fraud

It’s hard to imagine that there are Medicare and Medicaid healthcare providers who are greedy enough (and able) to manipulate our national healthcare program for their own personal gain. But it happens every day in North and South Carolina, and one way it’s done is with Medicare and Medicaid upcoding fraud.

At Carolina Whistleblower Attorneys, we’re experienced in pursuing whistleblower claims in North and South Carolina for people who suspect medical upcoding 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 upcoding fraud seen in Medicare and Medicaid billing

Greedy healthcare providers, including hospitals, doctors, home healthcare providers, and durable medical equipment providers (DME), engage in many different types of upcoding fraud which divert government funds to their own bank accounts, including:

• Diagnosis upcoding is billing for a more serious or complex diagnosis than the patient has.
  Example: Billing for a heart attack when the patient only experienced chest pain
• Procedure upcoding is billing for a more complex or invasive procedure than the one that was performed.
  Example: Billing for a major surgery when only a minor procedure was performed
• Time upcoding is exaggerating the time spent with a patient during an office visit or procedure.
  Example: Billing for an extensive home health care visit when it was a routine check-in visit
• Equipment upcoding is billing for more expensive equipment than provided.
  Example: Charging Medicare/Medicaid for an expensive electric wheelchair but providing a basic manual wheelchair

How do I report suspected Medicare or Medicaid upcoding billing fraud?

To report suspected upcoding fraud (and possibly receive an award for your efforts), you can “blow the whistle” on the provider by working with an experienced whistleblower attorney to file a qui tam lawsuit on behalf of the government under the False Claims Act. This may involve:

1. Evaluating your evidence
2. Building your case
3. Filing a qui tam lawsuit under the False Claims Act
4. Coordinating with the government in the investigation of the upcoding billing healthcare fraud allegations
5. Hopefully reaching a successful resolution to the government’s case
6. Negotiating with the government to try to get you the maximum award – up to 30% of the government’s potential recovery
7. Advocating on your behalf throughout the whistleblowing process

How Carolina Whistleblower Attorneys can help you fight Medicare and Medicaid upcoding fraud

If you suspect Medicare or Medicaid fraud and are considering taking steps towards exposing it, it’s important to know your rights. And we can help. Our whistleblower team is led by former U.S. Attorney Bill Nettles. Under his leadership and 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 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, your interests come first every step of the way.

Whistleblowers play a critical role in identifying Medicaid or Medicare upcoding fraud schemes. If you suspect healthcare 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.

Contact us online or call 1-888-292-8852 today!