Hospitals are busy places and mistakes can happen to any doctor. However, if a hospital or doctor exhibits a pattern of administrative errors, it could be an attempt to get more money from Medicare or Medicaid.
If you know the signs of Medicare or Medicaid fraud, reporting it can save taxpayers millions and lead to a whistleblower reward for you under the False Claims Act. Here are potential signs a hospital or doctor is willfully engaging in fraud:
Unspecified or redundant bills
Many hospitals require specific billing on all patients, usually breaking a bill down into each service rendered and their respective codes. However, if a practitioner’s billing is frequently opaque, they might be unnecessarily billing for their time. General descriptions or vague explanations for treatments could be an attempt to overcharge Medicare or Medicaid.
Another method consists of bundling all services into one major bill, and then also charging each procedure or treatment separately. If a doctor sets a patient’s broken arm, for instance, they could bill for the general “arm treatment” and also include setting the bone, x-rays and consultation. In essence, doubling the billing for the same procedure.
If a doctor is often submitting general bills that feature only vague descriptions of procedures or bills for unnamed services, it could be Medicare or Medicaid fraud.
Receiving kickbacks for referrals
In busy healthcare markets like Houston, hospitals compete for patients. This can lead to certain hospitals offering out-of-network doctors incentives for referring patients to their facilities. These kickbacks can include straight monetary rewards or things like reduced rent for a new office.
These kickbacks may increase based on the number of people he or she refers to the specific hospital. If a physician constantly refers clients to a single hospital, no matter their circumstances, it could be because they have added incentive to do so.
Overtreatment of patients
Doctors committing Medicare or Medicaid fraud will aim to bill as much as possible per patient. This can lead to overtreatment for patients. Ordering unnecessary x-rays, invasive surgeries or expensive experimental procedures can all be factors of fraud. The higher cost of treatment, the better for the hospital or doctor.
If a hospital (or an individual) continually seems to go above and beyond in the treatments pursued, it could be because their goal is to have the highest billing amount and not concern for their patients’ wellbeing. These overtreatments are harmful to both patients and taxpayers.
What can you do?
If you suspect Medicare or Medicaid fraud is taking place in your hospital, you have options. The first step should be to speak to an experienced whistleblower and Qui Tam attorney. They can help you navigate the Federal False Claims Act.
As a whistleblower, you can save taxpayers millions of dollars and protect vulnerable patients from exploitation. You may also be rewarded for helping the government shut down an attempt to abuse these federal programs.