Are Reporters of Medical Fraud Protected by Whistleblower Laws?
Whistleblower laws were created to encourage citizens who are aware of fraud to step up and report it. These laws not only protect those who come forward, but also make it possible for them to be rewarded monetarily when the case of fraud that they report results in the government recovering financial damages. There are many types of industries that whistleblower laws apply to, and medical fraud is one of the most important and most frequently reported. Medical fraud is one of the major reasons why our nation’s healthcare costs are skyrocketing, and it is very much in the government’s interest to provide those who work within the industry an incentive to report wrongdoing when they become aware of it. If you are an employee or contractor within the medical field and you are aware of medical fraud being perpetrated, then the whistleblower laws are there to protect you. The attorneys at the Philadelphia law firm of Bochetto & Lentz have a record of successfully representing whistleblowers in medical fraud cases, and can provide you with the information and counsel that you need.
Medical fraud can take many different forms. Some of those that are most frequently reported in whistleblower cases include:
- Provider submitting claims for services not rendered. This may be for treatments, testing, medical devices, or medication.
- Provider submitting claims for services, treatments, medical devices or medication for a patient that does not exist, or for whom they never provided services.
- Provider engaging in any kind of kickback scheme that includes the offer, payment, solicitation or receipt of compensation of any kind for the referral of patients of healthcare services payable by Medicare, Medicaid or another government health care program
- Using up-coding in order to bill the government or private health insurance companies to pay for a service or procedure that was more expensive then the one that was actually performed or provided.
- Unbundling services that are normally bundled together in order to bill at a higher rate instead of the discounted rates that would be applied when the services are bundled.
- Provider submitting claims for services, treatments, medical devices, or diagnostic tests that are not medically necessary.
- Provider, hospital or health care provider, pharmaceutical company or pharmacy benefits managers providing false certifications.
- Research grant fraud, including falsifying an application to secure grant funding, falsifying data and results, or overbilling for the costs of running a grant.
- Physicians and providers having a direct or indirect financial interest in the services that they are referring patients to.
- Hospitals red-lining patients, discouraging them from being treated if they are too sick in order to maximize the fixed amount of payment that they receive from insurance companies.
There are many other forms of medical fraud, and all of them end up costing the consumer. That is why the government provides reporters of medical fraud with whistleblower protection.
Filing a whistleblower lawsuit is a complex process, and it is important that before you act, you seek the advice of an experienced whistleblower attorney. Call Bochetto & Lentz today and we will provide you with the information that you need.