Medical Billing Fraud Whistleblowing

December 7, 2022
How to report medical billing fraud?

Introduction to Medical Billing Fraud

Medical billing fraud is a serious issue that can have a major impact on healthcare providers and patients and worse put heavy strains on the payors, like private insurance companies, or with the government also implicate Medicare Fraud or Medicaid Fraud. If you are aware of a company systemically defrauding insurance or that has committed a massive fraud and doesn’t want to pay it back you should learn what your options are as a whistleblower.

In this blog, we provide a step-by-step guide on how to report medical billing fraud and potentially receive a whistleblower award.

The first step is to speak with a whistleblower law firm. If you intend to blow the whistle on Medicare Fraud, or Medicaid Fraud as an insider, the False Claims Act statute could provide you with a whistleblower award up to 30%, if you know of systemic fraud against an insurance company in Illinois or California, you could receive up to 50% as a whistleblower reward. The key is you need to blow the whistle the right way.

Counterintuitively, if you report the fraud directly to the government it could complicate your ability to collect a whistleblower award at the end of the matter as you need to properly invoke the False Claims Act or California Insurance Claims Fraud Prevention Act for California insurance fraud or the Illinois Insurance Claims Fraud Prevention Act for Illinois.

However, if you are the patient or on behalf of a patient and believe you’ve been billed erroneously then you should ask the provider the reason for the bill and give them an opportunity to correct it. If you do not have evidence of a fraud that goes beyond you as the individual patient, its doubtful, but not impossible, to make a case along those lines and in all likelihood you would not be entitled to a whistleblower award. Although, some medical billing fraud cases have been established through outsiders, there were able to provide information that was specific to show that the billing scheme extended well beyond their individual matter.

The whistleblower statutes are mainly constructed to reward insiders for providing information the government wouldn’t have ordinarily have known and incentivize them to come forward as a whistleblower. Whistleblower laws are a complicated body of law and it’s best to consult with a whistleblower law firm to understand your particular rights. Some of the laws one may invoke to combat Medicare Fraud and Medicaid Fraud, under the False Claims act require the use of a whistleblower lawyer – that is you can’t file the whistleblower claim without a qui tam law firm. Other whistleblower laws have interesting facets that if invoked properly allow you to proceed anonymously through the use of a whistleblower law firm, such as the SEC whistleblower program using an SEC whistleblower attorney, the CFTC whistleblower program and the nascent AML whistleblower program (anti-money laundering) whistleblower program.

Another critical step in establishing a billing fraud case is gathering the proper evidence. It’s all the more reason to retain whistleblower counsel who can guide you on the dos and don’t of gathering evidence. One universal rule, is that you must preserve any and all evidence that relates to your case. If you’ve recorded evidence on your cell phone, for example, you should not trade in or otherwise destroy that cell phone as it may have the original evidence integral to proving your case. HIPPAA protected information will require you properly invoking exceptions to HIPPAA which exist to unearth fraud. But you want to make sure you do it in conformity with the law or else your employer may be the one suing you!!!

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Gathering Relevant Documentation

Gather all of the relevant documentation that relates to the suspected fraud. This may include medical bills, receipts, and any other paperwork that you have received from the healthcare provider in question. Make sure to keep copies of all of this documentation for your own records. You can contact Brown, LLC for a free confidential consultation. Brown, LLC is a leading law firm that experienced in whistleblower medical billing fraud cases. We will be able to help you understand your rights and take legal action against the healthcare provider if necessary.

Reporting Medical Billing Fraud

If you suspect that medical billing fraud is taking place, it’s important to report it. Not only can this help protect others from falling victim to the same fraud, but it can also help to protect the integrity of the healthcare system as a whole. It’s important to note that you do not need to have all of the answers or evidence in order to report medical billing fraud. Brown, LLC will work with you to gather the necessary information and evidence to investigate the case.

Blowing the whistle can have a tremendous upside as whistleblowers receive hundreds of millions of dollars each year for doing the right thing – but past results don’t guarantee future success.  But, if you have any doubts about whether or not something is considered medical billing fraud, it’s always better to err on the side of caution and have a free consultation with an experienced whistleblower law firm like Brown, LLC, a firm led by a former FBI Special Agent.

What Is Upcoding in Medical Billing

Upcoding is a pervasive type of medical billing fraud. Providers who engage in upcoding deliberately submit incorrect codes to insurance companies or government programs like Medicare and Medicaid. These codes represent more expensive services or diagnoses than those actually provided. This is done to increase reimbursement amounts, effectively defrauding insurers and taxpayers. Detecting upcoding can be challenging, but methods include comparing a practice’s coding patterns to those of similar providers. Additionally, whistleblowers working under the False Claims Act have been instrumental in exposing upcoding schemes, leading to significant recoveries of fraudulently obtained funds.

Seeking Legal Help from Brown, LLC

To contact Brown, LLC and report medical billing fraud, you can call our offices at (877) 561-0000.

Don’t let medical billing fraud go unreported. Contact Brown, LLC today and take the first step in protecting yourself and others from this type of fraud.