Medical Billing and Coding Fraud

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Whistleblowers who uncover fraudulent medical billing or coding may be entitled to significant monetary awards and protection under federal law.  The False Claims Act (FCA) allows individuals who uncover fraud against government programs to file a civil action to assist in the recovery of assets.  The majority of claims brought under this law involve the healthcare industry.  Commonly, these cases involve fraudulent coding and billing practices aimed at the Medicare and Medicaid programs.

Common fraud schemes against Medicare and Medicaid include (1) upcoding a service to as higher rate of reimbursement; (2) billing a code with insufficient service time; (3) charging for services rendered by a nurse practitioner at the higher reimbursement rate for physician services; (4) improperly waiving copays; and (5) billing for services that were not medically necessary or services that were not rendered.

Under the FCA, civil damages are assessed at three times the total amount of fraud, plus civil penalties of up to $10,000 for each fraudulent submission.  Whistleblowers who assist the government in these recoveries are entitled to a share of any recovery, ranging between 15 to 30% of the total amount recovered.  Whistleblowers are also protected from retaliation in the workplace.  If they are fired, demoted, or discriminated against in any other way by their employer for reporting the fraud, whistleblowers are entitled to additional recovery.  This includes two times backpay and reinstatement.  

If you have uncovered fraud against the government, contact the whistleblower lawyers at Miller Law Group today for a free and confidential consultation.  You can also set up your consultation by calling us at (919) 348-4361.  To learn more about whistleblower law, click here.

Additional Resources:

Medicare and Medicaid Fraud – Kickbacks and Self-Referrals

Telemedicine Fraud: Safely Distanced or a Smoke Screen?

Filing a Whistleblower Lawsuits in Secret – The Seal Period