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Health Care Fraud No Company Is Too Big to Play Fair

Healthcare Whistleblower Attorneys

Fraud in Government Health Care

Millions of Americans, including the elderly, low-income, and individuals with disabilities, participate in government-funded health care programs, such as Medicare and Medicaid. The U.S. government spends more than a trillion dollars on health care programs annually, representing a substantial portion of the federal budget. It is therefore not surprising that health care fraud makes up a significant portion of the False Claims Act lawsuits each year.

Types of Health Care Fraud

There are many types of health care fraud. One is the knowing submission of a claim for payment that is factually false on its face. Factual falsity occurs when a health care provider, such as a physician or a medical facility, submits claims to the government for reimbursement for services that were never provided or were not provided as described.

This can include:

  • Billing for services that were not rendered (e.g., billing Medicare for tests that were never performed)
  • Upcoding (billing for more expensive services than those actually provided)
  • Unbundling and fragmenting (billing the components of procedures separately to increase profits)
  • Submitting claims for non-existent patients

Factual Falsity vs Legal Falsity

It is important to distinguish between factual falsity and legal falsity. A legally false claim is one where a provider knowingly and falsely certifies compliance with a statute or regulation as a condition for government payment. A claim for reimbursement can be legally false when a provider certifies that the services rendered were medically necessary and appropriate under the terms of the health care program when they in fact are not. An example of this occurs when a physician orders unnecessary tests or procedures to increase revenues.

If you believe you have information about health care fraud, please contact us for a confidential consultation. Our experienced attorneys are here to help you navigate the process and protect your rights.

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