Medicare, Medicaid, and you are being robbed.
Here’s how you can recognize and report other types of Medicare and Medicaid fraud beyond billing and kickbacks. You can make a difference – and possibly get a reward.
Other Types of Medicare and Medicaid Fraud in North and South Carolina: It’s Not Just Billing Fraud and Kickbacks
Medicare and Medicaid fraud costs taxpayers like you a staggering amount of money each year in funds that should be going toward the public’s care.
Billing fraud and kickbacks are the most prevalent ways unscrupulous companies and individuals steal from government healthcare programs, but there are many other types of Medicare and Medicaid fraud to watch for in North and South Carolina. While some schemes may not seem as serious as others, they are all illegal and should be reported.
Whistleblowers play an integral role in spotting and stopping healthcare fraud. If you suspect any type of Medicare or Medicaid fraud, call us today at 1-888-292-8852 or contact us online for a free, confidential conversation.
Examples of different types of Medicare and Medicaid fraud
Here is a list of different types of fraud (in addition to billing fraud and kickbacks) you may observe in Medicare or Medicaid settings.
Providing false information
- Billing for services not rendered to patients
- Falsifying patient diagnoses to justify unnecessary medical procedures
- Creating fake medical records to support fraudulent claims
- Submitting claims for ghost patients who don’t exist
Prescription fraud
- Creating counterfeit prescriptions
- Altering legitimate prescriptions to obtain higher quantities or different medications
- Selling blank prescription forms to drug dealers
- Using stolen physician identities to write fraudulent prescriptions
- Charging for brand-name drugs when generics were provided
Using transportation benefits for non-medical purposes
- Claiming reimbursement for personal trips under the guise of medical appointments
- Billing for longer distances than actually traveled for medical visits
- Using medical transportation services for recreational outings
- Falsifying trip logs to inflate the number of medical transports provided
Fraudulent patient enrollment practices
- Creating fake identities to enroll non-existent patients in healthcare programs
- Manipulating income information to qualify ineligible individuals for subsidized healthcare
- Enrolling deceased individuals to continue receiving benefits
- Misrepresenting residency status to enroll patients in out-of-state programs
Misrepresenting provider qualifications
- Performing medical procedures without proper licensing or certification
- Using forged diplomas or credentials to gain employment in healthcare facilities
- Billing for specialist services when only general practitioner qualifications are held
- Falsely claiming board certifications or specializations
Improper retention of overpayments
- Ignoring notifications of overpayments from Medicare or Medicaid
- Deliberately miscalculating refunds owed to Medicare or Medicaid
- Creating false documentation to justify keeping overpayments
- Delaying repayment of identified overpayments beyond the required timeframe
Patient recruitment fraud
- Offering cash incentives or other benefits to patients for unnecessary medical visits
- Providing free services or goods in exchange for using specific healthcare providers
- Paying “recruiters” to bring in patients for unnecessary treatments
Kickbacks and Stark Law violationsThe Stark Law prohibits physicians from referring Medicare and Medicaid patients for certain services to medical businesses with which the physician has a financial interest.
- Pharmacies or doctors accepting improper financial incentives or bribes
- Physicians referring patients to imaging centers they own for unnecessary scans
- Surgeons directing patients to use medical device companies in which they hold stock
- Doctors referring patients to labs or pharmacies owned by family members
- Hospitals providing financial incentives to physicians for patient referrals
Unnecessary medical services
- Performing unnecessary surgeries to increase billing
- Ordering excessive lab tests not necessary for the patient’s condition
- Recommending frequent follow-up visits without medical justification
- Offering discounts on legitimate services in exchange for agreeing to unnecessary procedures
Altering medical records
- Modifying patient diagnoses to justify unnecessary treatments or procedures
- Falsifying test results to support fraudulent insurance claims
- Adding non-existent symptoms or complaints to patient charts to justify additional services
- Changing dates of service to circumvent insurance coverage limitations
- Deleting or omitting information about pre-existing conditions to ensure insurance coverage
Reporting suspected Medicare and Medicaid fraud
Medicare and Medicaid fraud is not always easy to detect but if you suspect it, you may want to follow these steps:
- Call an experienced whistleblower lawyer immediately before speaking to anyone else – especially co-workers and HR – to confidentially discuss your observations and options. (Note: The first person to come forward with actionable evidence and information is usually the one who receives a whistleblower reward when one is given.)
- Gather evidence quietly and quickly.
- Have your whistleblower lawyer file a False Claims Act (FCA) lawsuit with the government.
- Cooperate with the government to provide any additional information requested.
At this point, the government will let you know whether it will intervene in the case (with your continued assistance) or not. In the latter scenario, you and an experienced whistleblower lawyer can then decide whether you want to pursue the case (and possible reward) on your own.
Call 1-888-292-8852 or contact us online today for a free and confidential consultation about your suspected Medicare or Medicaid fraud case. Our experienced team will review your situation and can help you report fraud effectively while safeguarding your privacy.
Confidentiality when reporting Medicare or Medicaid fraud
If you report Medicare and Medicaid fraud by filing a whistleblower lawsuit under the False Claims Act, the complaint will be “under seal” for at least 60 days. During this time, your identity is privileged information and is not allowed to be shared with anyone outside the case.
At Carolina Whistleblower Attorneys, we put your rights and protection first. As part of our You-First Policy, we help protect you from retaliation and can fight back under federal law if anyone engages in it.
How Carolina Whistelblower Attorneys helps whistleblowers like you
Our experienced whistleblower team can file a whistleblower lawsuit under the False Claims Act (FCA) in North and South Carolina (non-attorneys cannot file the lawsuit on their own). As part of this process, we can:
- Coordinate with government attorneys and follow the strict government protocol associated with these cases
- Work efficiently to file your claim as early as possible in the process – the first person to file a complaint is in the best position to receive a potential reward, which can be in the millions
- Guide you on the pros and cons of filing an FCA claim
- Build your case and help you try to secure key proof
- Help protect you from employer retaliation
- Ensure you retain your eligibility for a reward throughout the process
- Fight for the maximum possible reward on your behalf in a successful case
At Carolina Whistleblower Attorneys, we have the experience and resources to help you report all types of Medicare and Medicaid fraud in North and South Carolina. We’re led by former White House-appointed attorney Bill Nettles and his team. During his tenure as U.S. Attorney, Bill’s office brought the state of South Carolina to top four in the country for whistleblower recoveries.1,4
Our goal is to stamp out corporate greed while protecting those who do their patriotic duty by blowing the whistle. We have decades of combined experience in successful whistleblower cases, know what makes a good case, and can help you try to minimize any risks.1,4
Call 1-888-292-8852 or contact us online today for a free, confidential conversation about your Medicare or Medicaid fraud whistleblower case.
FAQs
What are common types of Medicare and Medicaid fraud?
Besides billing fraud and kickbacks, other forms of Medicare and Medicaid fraud include false claims (altering medical records, providing false information, misrepresenting provider qualifications), illegal actions (prescription fraud, using transportation benefits for non-medical purposes, fraudulent patient enrollment or recruitment, improper retention of overpayments), and Stark Law violations.The Stark Law prohibits physicians from referring Medicare and Medicaid patients for certain services to medical businesses with which the physician has a financial interest.
Are there protections for whistleblowers who report Medicare or Medicaid fraud?
Yes, a whistleblower lawyer can help protect you against employer retaliation for reporting Medicare/Medicaid fraud in North and South Carolina. Under the False Claims Act (FCA), your employer is prohibited from punishing you in the following ways and more:
- Discrimination
- Harassment
- Firing
- Demotion
- Suspension
- Involuntary relocation
- Making your work environment inhospitable
- Blackballing you from the industry
Furthermore, federal law gives whistleblowers who face retaliation several potential remedies, such as job reinstatement, double backpay compensation, and reimbursement for litigation costs and attorney fees.
Can I get a financial reward for reporting any type of Medicare or Medicaid fraud?
Yes, you can potentially receive a financial reward for reporting Medicare or Medicaid fraud. If the lawsuit is successful, the whistleblower is typically entitled to a portion of the government’s recovery – up to 30%, which could be a life-changing amount in the millions of dollars!prote