Do You Have Evidence of a Healthcare Provider’s Billing Scheme to Defraud Medicaid?
State False Claims Acts help recover money lost in Medicaid programs by making it illegal for medical providers to defraud Medicaid and calls for triple damages from healthcare providers including hospitals, pharmacies, physicians and others who commit fraud.
When a Medical provider (dentist, physician, mental health provider) or Medical facility (hospital, clinic, pharmacy, nursing home, home care agency, medical transportation company, durable medical equipment company, pharmaceutical company) bills Medicaid for products or services not provided, double bill, upcode, unbundle costs or submits claims for ineligible patients they are guilty of Medicaid fraud because of their billing scheme.
You might be entitled to a reward for reporting a billing scheme that cheats Medicaid.
Common Medical Provider Illegal Fraudulent Billing Practices
If you have information regarding a violation of your state’s False Claims Act through fraudulent billing practices, you could receive a cash reward for your information and evidence. Typical billing schemes that Medical providers use to defraud state Medicaid programs include:
- Billing for products or services not provided: Billing Medicaid for products or services, such as treatments, laboratory work, diagnostic tests, x-rays, medical devices or pharmaceuticals, when the patient never actually received the product or service.
- Upcoding: Billing for a comprehensive procedure when only a limited procedure was provided, billing for a brand name pharmaceutical while providing the generic form, or billing for expensive equipment while supplying used or damaged equipment.
- Unbundling: Supplying products or services for which Medicaid offers discounted grouped reimbursement rates (for groups of procedures routinely performed together), but billing for each procedure separately.
- Billing for medically unnecessary services: Billing for diagnostic procedures, treatment protocols, pharmaceuticals, or medical equipment that is not medically necessary for the recipient (often via false diagnosis or symptom reports).
- Double billing: Submitting claims to both Medicaid and a private insurance company for products or services, or submitting a claim for products or services already rendered and billed for by another provider on the same date.
- Billing for ineligible patients: Submitting claims to Medicaid for patients who are ineligible for Medicaid coverage, whose Medicaid coverage has expired, or who are deceased. May involve Medicaid ID theft.
A Whistle Blower Who Reports a Medicaid Fraud Billing Scheme Can Earn a Reward
Your state False Claims Act has a whistle blower section providing for money rewards up to 30 percent of any money recovered for the person who was the first to report a Medicaid billing scheme with inside evidence or information and helped with a Medicaid fraud case.
Medicaid whistleblowers are protected from losing their jobs by strong anti-retaliation provisions in the state False Claims Acts making it illegal to fire or demote an employee for reporting fraud.