Articles Posted in Healthcare Fraud

jonathan-perez-409943-copy-300x200During this final week of Medicare open enrollment, you may receive multiple calls each day regarding your Medicare coverage. Many of these calls may be scams, and unless you know exactly what to watch out for, these scams can be difficult to spot. Make sure you follow the guidelines below and report any Medicare fraud you detect to the proper agencies. If you believe your employer or healthcare provider is the one committing the fraud, contact the qui tam attorneys at Willoughby Brod to learn how you can report the fraud and receive an award for your tip.

Four Tips for Avoiding Medicare Scams

  1. Do not give out your Medicare number to anyone other than your doctor or someone who should have it.

james-williams-502481-unsplash-copy-300x225There is no such thing as “good” fraud, but on the hierarchy of Medicare fraud from bad to worst, hospice fraud is arguably one of the most despicable types. Medicare Part A covers hospice care for patients who are “terminally ill,” or have a life expectancy of six months or less. If you believe you have witnessed hospice fraud, make it your duty to report the fraud and honor an individual’s last moments in this world. The whistleblower attorneys at Willoughby Brod are experienced at helping whistleblowers bring their claims forward and protecting them in the process. Contact us today for a free consultation and to learn how we can help.

What Does Medicare Provide by Way of Hospice Care?

As mentioned above, Medicare Part A covers hospice care for patients who are deemed by a medical professional to be terminally ill, which is defined as having a life expectancy of six months or less. Medicare covers only hospice care for terminally ill patients and not any curative treatments, although hospice patients can continue to receive curative care coverage for conditions unrelated to the cause of their terminal illness.

hans-reniers-746177-unsplash-copy-300x200One common category of healthcare fraud schemes in the medical laboratory industry revolves around medically unnecessary testing. There are many different ways in which the medical laboratory industry fraudulently commits medically unnecessary testing, which are highlighted below. If you believe you have witnessed healthcare fraud involving medically unnecessary testing, contact the healthcare fraud attorneys at Willoughby Brod to learn more about what you should do next.

What is Medically Unnecessary Testing?

Medically unnecessary testing occurs when clinical laboratories order tests that are excessive, unnecessary, or inappropriate for a patient’s treatment. Not only can this be extremely costly, it can also be dangerous to a patient’s life.

samuel-zeller-360588-copy-200x300Though similar in purpose, the Anti-Kickback Statute (AKS) and Stark Law have many differences that are often overlooked or ignored by the general public. If you believe you have witnessed a form of healthcare fraud but are unsure whether the fraudulent act was a violation of the AKS or Stark Law, contact one of the experienced AKS and Stark Law attorneys at Willoughby Brod today for your free case review.

What is the Anti-Kickback Statute?

The AKS provides that physicians and hospitals are not permitted to refer patients to other healthcare providers in exchange for something of value, whether in cash or another form. The purpose of this statute is to ensure that referrals are genuine and based on merit rather than based on familial or professional networks.

ken-treloar-385255-copy-300x200Even though the Anti-Kickback Statute is a federal criminal statute that results in serious penalties when violated, it is also one that physicians and healthcare professionals violate on a regular basis. If you believe you were referred to a physician or other healthcare provider as part of a monetary or other valuable exchange, you may have witnessed an Anti-Kickback Law violation. However, there are certain “safe harbors” that protect physician payment plans that would otherwise constitute a violation under the Anti-Kickback Statute. If you are unsure whether your physician’s payment plan falls into one of the safe harbors, contact the attorneys at Willoughby Brod to get your questions answered.

What is the Anti-Kickback Law?

The Anti-Kickback Statute says that physicians and hospitals are not permitted to refer patients to other healthcare providers in exchange for something of value, whether that is cash or something else. The purpose of this statute is to ensure that referrals are genuine and based on merit rather than based on familial or professional networks.

hush-naidoo-382152-copy-300x200With the development of big data and predictive analytics, it is easier today than ever before to detect and prevent healthcare fraud. Gone are the days of lengthy, old-fashioned investigation, and here to stay are new technologies that can identify fraudulent activities automatically and instantly. By parsing through big data and analyzing payment trends, predictive analytics softwares can identify inconsistencies in payment and seemingly fraudulent activity. This article delves deeper into the system that mines data and predicts fraud by explaining the many components that make up a fraud detection software. If you are interested in learning more about how you can use technology to detect healthcare fraud, contact our attorneys today to learn more.

Link Analysis

Link analysis focuses on measuring relationships. It mines and analyzes data relating to how individuals, healthcare providers, healthcare employees, and healthcare suppliers are related to and interact with one another. It can identify unusual interactions and even unusual identities, such as multiple or fake addresses and phone numbers.

markus-spiske-666905-unsplash-copy-300x200With about one-third of the cost of the healthcare industry in the U.S. lost to fraud, waste, and abuse, it is vitally important to society that we report healthcare fraud when we see it. While it is certainly helpful to familiarize yourself with the most common healthcare fraud schemes and pay close attention to all bills received from your healthcare provider, it is not always easy – or possible – to detect healthcare fraud with the naked eye. Thanks to technology and the development of big data, however, there are new and improved ways to detect healthcare fraud today that have never before existed. Below is a brief overview of how you can use big data to help combat healthcare fraud. If you believe you have witnessed healthcare fraud, contact one of our attorneys today to find out how you can report your claim and initiate a whistleblower lawsuit.

Common Types of Healthcare Fraud

The most common type of healthcare fraud is fraudulent billing. Healthcare providers may bill for services that were never rendered, or bill for a more expensive service than the one that was rendered. For example, a doctor might bill a patient for a two-hour visit when in fact the visit was only one hour long. Fraudulent billing in the medical space is so common that it accounts for up to 10% of annual healthcare costs in the U.S.

ken-treloar-385255-copy-300x200Medi-Cal fraud occurs more frequently than you think and often goes unnoticed. Unfortunately, this only harms recipients and future recipients of Medi-Cal who desperately need this healthcare assistance program in order to obtain the medical treatments they require. As a whistleblower, you have the opportunity to help put an end to Medi-Cal fraud by reporting healthcare providers and professionals who engage in fraudulent acts. If you detect any fraudulent acts by your healthcare provider, contact the healthcare fraud attorneys at Willoughby Brod today to learn more about how you should proceed with your whistleblower claim.

What is Medi-Cal?

Medi-Cal is a California Medicaid program for low income adults and children that is supported by both federal and state taxes. Those who qualify for Medi-Cal can receive free or low-cost healthcare services and generally receive the same benefits offered under Covered California but at much discounted or free prices. Anyone can apply for Medi-Cal regardless of age, sex, race, religion, sexual orientation, color, national origin, marital status, disability, or veteran status.

israel-palacio-463979-copy-300x200With the high number of TRICARE fraud cases in the United States, it is no wonder that healthcare fraud is the second highest priority of focus for the U.S. Department of Justice. The $2.7 trillion healthcare industry is an enticing target for those wanting to commit healthcare fraud, which is defined as purposefully misrepresenting a medical treatment or product in order to receive a higher benefit. In fact, Humana Military has estimated that 7-10% of the $2.7 trillion industry is fraudulent. If you suspect your doctor is committing TRICARE fraud, call an experienced qui tam lawyer at The Brod Law Firm today to learn more about how you can report your case as a whistleblower.

What is TRICARE?

TRICARE is a federal healthcare program, similar to Medicare, for uniformed service members, retirees, and their families. TRICARE provides comprehensive coverage to its beneficiaries, including general health plans, special programs customized for beneficiaries, prescriptions, and dental plans.

hush-naidoo-382152-copy-300x200Insurance fraud can take place across multiple industries, from automobile insurance to medical insurance to property insurance. In most cases, the victim does not even know that he or she has been defrauded. By making yourself aware of common insurance fraud schemes in California, you can better equip yourself to identify insurance fraud when it occurs and help stop insurance fraud in California. If you believe you have witnessed an incident of insurance fraud, call Brod Law Firm at (800) 427-7020 today to speak with an experienced qui tam attorney and learn how you can help.

What is Insurance Fraud?

The California Penal Code defines insurance fraud as the willful injury, destruction, or disposition of any property that is insured against loss or damage. Consumers and businesses alike can be guilty of insurance fraud. While a consumer might be found committing insurance fraud by submitting a claim to his or her insurance company based on false injuries, a business might be found committing insurance fraud by inflating the cost of their services or billing for services that were never performed. While insurance fraud can take place in just about any industry, the most common industries in which insurance fraud is seen are the automobile, healthcare, workers’ compensation, property insurance, and life insurance industries.