Medical billing fraud can occur in a variety of ways. Some of the most common ones are upcoding, unbundling, and billing for services that were not provided. Many other fraudulent schemes exist, however. When a provider submits a fraudulent bill for payment, they may be liable under the False Claims Act, and whistleblowers pay a critical role in exposing this kind of fraud.
The Government will only pay for medical services that are actually performed or for equipment that is actually delivered. It can be a violation of the False Claims Act to bill the Government for healthcare services, supplies or equipment that were not performed or delivered. While sometimes bills are submitted for completely fictional services, medical billing fraud also happens when, for example, a diagnostic testing lab submits a bill claiming it has performed both a two dimensional CAT scan and a sophisticated 3D scan and analysis, when, in fact, only the 2D scan was performed. They are billing for service that was not actually provided.
Our law firm has compiled a FAQ resource for potential whistleblowers that may be of interest to you:
https://constantinecannon.com/practice/whistleblower/i-think-i-have-a-whistleblower-case/.
The information contained herein is for informational purposes only and is not legal advice or a substitute for legal counsel. Online readers should not act upon this information without seeking professional counsel. If you would like more information, or would like to speak to a member of Constantine Cannon’s whistleblower lawyer team, please contact us for a Confidential Consultation:
https://constantinecannon.com/practice/whistleblower/team/.
