Medical Billing Fraud in North Carolina

Our law firm fights medical billing schemes and other healthcare fraud that costs taxpayers billions of dollars and impacts government programs. Submitting fraudulent medical bills to any federal or state program, including Medicare and Medicaid, violates the federal False Claims Act and the North Carolina False Claims Act. The consequences could include substantial fines, treble damages, and possible criminal prosecution.

Healthcare whistleblowers who report medical billing fraud through a qualified law firm are protected under the North Carolina and federal False Claims Acts. These laws encourage whistleblowers to report fraudulent billing practices, and the FCA allows whistleblowers to receive a percentage of any recovery.

The attorneys at our medical billing fraud law firm have seen many healthcare professionals and facilities exploit federal programs for financial gain. Those committing healthcare fraud can be individuals or an organized group. Patients and practitioners must understand what constitutes fraud in the healthcare industry so they can recognize and report these schemes. Whistleblower attorneys in Raleigh, N.C., or any nearby city can then help with the appropriate legal procedures. Some common activities that qualify as healthcare fraud include:

• Upcoding: Billing for services that are more complex than the actual service provided.
• Double-Billing and Unbundling: Submitting bills for fragmented services, such as individual tests rather than a panel, to maximize reimbursement.
• Billing for Unnecessary Services or Items: Intentionally authorizing services that aren’t medically necessary.
• Billing for Services Not Provided: Some providers may bill Medicaid for a covered service without providing it and create false records to justify the bill.
• Kickbacks: Offering, soliciting, or receiving remuneration in return for referral patients whose care is provided under federal healthcare programs.

If you are aware of fraudulent billing, it is important to speak with an experienced whistleblower lawyer in Raleigh, North Carolina, before reporting the fraud. If the fraud is not reported correctly, a whistleblower may forfeit any rights to an award.

Under the False Claims Act, whistleblowers are required to file claims called “qui tam” lawsuits. Qui tam lawsuits are filed on behalf of the state or federal government. The cases are filed under seal to give the government an opportunity to investigate the claim and decide whether to intervene. When the government intervenes, it takes over the primary responsibility for prosecuting the action. While a whistleblower does give up some control over the litigation this way, they also gain the power of the Department of Justice. An attorney from a medical billing fraud law firm can help make sure whistleblowers remain protected during this process.

If you’ve uncovered a provider’s scheme to charge excessive prices or incorrectly bill for services, contact a whistleblower attorney in Raleigh or nearby. Miller Law Group in Raleigh has experience representing whistleblowers who have reported medical billing fraud throughout North Carolina and the southeast. For a free consultation, contact Miller Law Group.