New York City Whistleblower Attorneys for Medicare and Medicaid Fraud

The False Claims Act is a federal law that compensates whistleblowers who report instances of Medicare and Medicaid fraud. If you are aware of a hospital, private medical practice, or other company in the healthcare industry that is wrongfully taking advantage of these entitlement programs, Schwartzapfel Lawyers P.C. can help you take action and make sure you receive the compensation you deserve.

The Medicare and Medicaid Systems are Regularly Abused

Medicare and Medicaid are government programs that help pay for medical treatment for the elderly and individuals who cannot afford to pay themselves. These programs are funded by tax dollars, and they cover billions of dollars’ worth of healthcare every year.

Unfortunately, being largely automated, these systems are also ripe for abuse. Fraudulent claims cost the government billions of dollars every year. Some of the most common forms of Medicare and Medicaid fraud are discussed below. If you believe that you may have information about Medicare or Medicaid fraud, we encourage you to speak with one of our attorneys today.

Examples of Medicare and Medicaid Fraud

Treatment Fraud

Some of the most prevalent forms of Medicare and Medicaid fraud directly involve the treatment that doctors and hospitals provide to their patients. For example, if a healthcare provider submits a Medicare claim for treatment never provided or a procedure never performed, this would be a relatively clear-cut case of Medicare fraud.

Healthcare providers can also face liability for providing worthless or deficient services. In short, just because a doctor, hospital, or nursing home does something, this does not mean that it is entitled to compensation. Inadequate care can often leave patients worse off instead of better, and in these situations, claims for Medicare and Medicaid reimbursement may constitute violations of the False Claims Act. In some cases, facilities receive a per-patient rate instead of being reimbursed based on the volume of treatment rendered. This often serves as a disincentive for facilities to order the tests and provide the care their patients deserve.

On the flip side, providing unnecessary treatment can be a form of Medicare and Medicaid fraud as well. When doctors and hospitals bill for tests and procedures that are not medically necessary, they are taking advantage of the system and their patients for their own financial gain.

Coding Fraud

When a healthcare provider bills the government for Medicare or Medicaid, it is required to submit documentation to support its request for reimbursement. Since the payment systems for these programs are largely automated, they employ a complex system of codes that are tied to the various tests, treatments, medications and procedures available.

When the services rendered to a provider’s patients do not align with the codes submitted for reimbursement, if done recklessly or intentionally, it can constitute an illegal false claim. While honest mistakes happen, some unscrupulous healthcare providers engage in the practice known as “upcoding” in order to bill for procedures that are more expensive than those that were actually performed.

Another form of coding fraud is called “unbundling.” The Center for Medicare and Medicaid Services provides guidelines on when healthcare providers should “bundle” various services into a single code. Sometimes, providers will bundle their services, and then “unbundle” them so that they can bill the government again for the exact same services.

Other Forms of Medicare and Medicaid Fraud

In addition to various forms of treatment and coding fraud, other common forms of Medicare and Medicaid fraud include:

  • Misrepresenting ineligible service providers as being eligible for Medicare or Medicaid reimbursement, and
  • Falsifying treatment records in order to bill under higher-priced codes.

Act Now to Seek Compensation for Your Whistleblower Claim

When seeking compensation as a whistleblower, there are certain requirements that must be met. In addition to these basic requirements, there are certain additional requirements that make it important to act quickly on your claim for compensation:

  • Statute of Limitations Under the False Claims Act – The statute of limitations under the False Claims Act is six years. However, determining when a violation occurred is not always clear-cut, and past violations may suggest a pattern that has continued past the cutoff date for pursuing a claim. As a result, if you are aware of a possible Medicare or Medicaid fraud, we encourage you to contact us regardless of whether you think the statute of limitations may have recently expired.
  • The First-to-File Rule – Another reason that it is important to take action quickly after uncovering evidence of possible Medicare or Medicaid fraud is the “first-to-file” rule. The False Claims Act states that only one whistleblower can receive compensation for a specific fraudulent claim. When two people file whistleblower claims for the same illegal activity, the one who files their claim first is the one who will be entitled to compensation. At Schwartzapfel Lawyers P.C., we will act swiftly to file your claim as soon as possible and preserve your right to compensation.

Get Started with Your Medicare or Medicaid Whistleblower Claim Today

Whether you are a patient, an employee of a healthcare provider, or a member of the general public, it is important to speak up if you have information about someone who is filing fraudulent claims with the government. The attorneys at the New York City law offices of Schwartzapfel Lawyers P.C. can help you disclose corrupt practices and make sure that you are justly compensated for your efforts and bravery. If you work for a company that is engaged in Medicare or Medicaid fraud, we can also help protect you against wrongful retaliation. To discuss your whistleblower claim in confidence, please contact us today.