Coders are trained to identify noncompliance and fraud.  When coders report illegal billing activity, they may receive whistleblower protection.

The False Claims Act rewards and protects whistleblowers who report fraud against government program, like Medicare and Medicaid.  Because most fraud goes unreported, congress enacted the False Claims Act to incentivize inside employees to report fraud by allowing whistleblowers to receive a percentage of any recovery.  The FCA also protects whistleblowers from workplace retaliation by their employers.

False Claim Act complaints are call “qui tam” lawsuits and are filed under seal – meaning in secrete.  Because the qui tam lawsuits are filed by whistleblowers on behalf of the government, the FCA requires whistleblowers to retain a lawyer.  When the government intervenes in the case, a whistleblower may receive up tho 25% of any recovery.

Certified Medical Coders (CMA) and other coders are often asked to participate in billing schemes that are considered fraudulent. Therefore, it is important for coders to recognize illegal billing schemes. The most common schemes include:

  • Billing for services or procedures that are not rendered;
  • Upcoding, or billing for services at a different level than was performed;
  • Falsifying medical records to satisfy medical necessity
  • Billings for medical services that are not necessary;
  • Unbundling, or report more CPT codes than necessary to increase the reimbursement rate.

If you are aware of improper billing practices, it is important to speak with and experienced whistleblower lawyer immediately.  Even an individual who knowing participates in improper billing schemes, can still receive protection under the the False Claims Act.

For a free consultation, contact Miller Law Group – or call 919-348-4361.

Whistleblower: Telehealth &; Medicare Fraud

Medicare and Medicaid Fraud Whistleblowers