Boca Raton Medicare Fraud Lawyer
One type of Medicare fraud occurs when medical providers falsify claims and services when billing Medicare. When Medicare fraud occurs, it can harm individuals who need the benefits of the program and taxpayers who pay for it. Patients and employees in healthcare can report this fraud when they are aware of it. These individuals can benefit from a Boca Raton Medicare fraud lawyer to help them prepare a report and protect their rights during the process.
The Law Offices of Gary A. Costales, P.A.: Addressing Healthcare Fraud
Illegal behavior like Medicare fraud should be reported. When you report governmental fraud, you may be able to recover a percentage of the monetary damages the government recovers. When you are an employee, however, you often must worry about your employment. Retaliation law protects employees from being terminated or facing other backlash for good faith claims, but this does not always stop retaliation from occurring.
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If you are an employee who sees violations and fraud in the workplace, having an attorney by your side helps you ensure your claim has validity and that you protect your rights against retaliation.
The Law Offices of Gary A. Costales, P.A., is a Medicare fraud law firm in Boca Raton, Florida. Our firm can help you as an employee or patient gather important information about Medicare fraud and navigate the process of reporting this behavior.
According to Medicare.gov, there are a couple of ways Medicare fraud can happen to you. One way is when a criminal gets your Medicare number and uses it to steal your identity so they can use your Medicare benefits for their benefit or for another person’s benefit. Another way is when hospitals or doctors bill Medicare for services that they don’t provide to you. Medicare billing fraud can cost taxpayers money, can lead to inflated health care costs, and hurt society as a whole.
Our attorney can help you defend your rights and help prevent wrongdoing in your workplace or your healthcare facility. We can help you if you are filing under the False Claims Act or have another type of claim. Our team wants to help you defend your financial future and hold medical professionals accountable for fraud.
What Are False Claims Act Claims in Medicare Fraud?
Under the False Claims Act, individuals who work for a healthcare provider that is engaging in improper billing practices may have the right to seek damages on behalf of the government and may be able to receive a part of the government’s recovery as a reward. However, when making these claims against your employer, it is important that you have evidence to back up your claims and it may be wise to have a Boca Raton Medicare fraud law firm like the Law Offices of Gary A. Costales, P.A., on your side. These claims can sometimes be complex and there are risks of making a claim against an employer if the employer is not engaged in wrongdoing, so speaking to a Medicare fraud law firm in Boca Raton, Florida can help you understand whether the practices you have witnessed are fraud or not.
Patients Reporting Medicare Fraud
Patients can also be on the front lines of reporting Medicare fraud. If patients see strange bills, notice that Medicare is being charged for services they never received, or if they are being referred to other clinics and providers where the physician making the referral has a financial interest, patients can speak up and take action. If you are a Medicare patient and notice irregularities in your bills, or witness Medicare fraud, you may also be able to bring forth a False Claims Act case against the provider. The Law Offices of Gary A. Costales, P.A., is a Boca Raton Medicare fraud law firm that may be able to assist you.
How Do Medical Providers Engage in Medicare Fraud?
There are several actions that medical professionals can take to defraud Medicare and enable them to receive illegal payments from Medicare. This includes:
- Billing for services that were not provided. A medical provider may submit false or misrepresented claims to receive payment from Medicare for a medical service or procedure that the provider never completed or for supplies that were not provided. This may include the provider billing for a patient’s appointment that they failed to show up for.
- Billing for unnecessary services. A patient may have no need for procedures, items, or services, but the medical provider provides them in order to receive the Medicare payment.
- Upcoding. This is the intentional misrepresentation of medical procedures by claiming they were more complex and expensive than the procedure actually was.
- Unbundling. This is when a medical provider bills services or procedures separately that are typically billed and performed together at a lower reimbursement rate. This increases the reimbursement rate they receive.
- Making illegal referrals. Prohibited referrals are when a provider refers a patient to a health service that the provider has a financial interest in.
- Kickbacks. This occurs when a medical provider offers, provides, or receives payment in exchange for referrals, including referrals of Medicare beneficiaries and referrals for specific medical devices or prescriptions.
- False certification. A medical provider may claim and falsely certify that a patient requires certain treatments in order to be reimbursed by Medicare.
These actions are illegal, and medical providers who engage in them may see civil or criminal penalties. Medical providers can also engage in many other methods of fraud, as well as healthcare facilities and companies that make or sell medical products. Employees are in a unique position to recognize fraud by a medical provider, and patients can also take steps to catch Medicare fraud.
Signs of Medicare Fraud You Can Watch for as a Patient
What are some signs of Medicare fraud? How can you tell as a patient that your health care provider might be committing Medicare fraud? Here are some things to watch for:
- Read through your medical bills. If you notice that Medicare is being billed for services that you did not receive, this could be a red flag.
- If you are being provided with medical treatments that you don’t think you need, you can always seek a second opinion from another doctor. Doctors who provide medically unnecessary treatments could be committing Medicare fraud.
- Coding issues. Doctors submit codes to Medicare for services they provide. When the codes are improperly used to increase the value of a bill, this could also be Medicare fraud. If you are a patient, it can sometimes be wise to research the services and codes for which you are being billed. Sometimes you might discover irregularities.
- Doctors who receive kickbacks for referring patients to certain medical services or for using certain types of drugs could also face penalties for Medicare fraud.
- Home Health Care Fraud. Another type of Medicare fraud can occur if a home health care service or nursing home bills Medicare claiming a physician or licensed practitioner is providing a service, and then Medicare learns that a person without a license or proper certification was providing the service.
- Clinics providing “free” services. Sometimes clinics tell Medicare patients that they are receiving “free” services only for the patient to learn that the service wasn’t free and that Medicare was billed. If this happens, you may have become a victim of Medicare fraud. You may want to report this instance because your identity could be compromised if someone has your Medicare information.
These are just some examples of Medicare fraud or billing fraud. Patients are often on the front lines when it comes to noticing these fraudulent practices. Sometimes billing errors occur. If you notice a billing error, you can always call your doctor and ask about your bill. Sometimes these errors are rectified with a simple phone call.
Retaliation Protections as an Employee
As an employee, you have legal protections against several types of retaliation in the workplace, including when you take protected actions. Reporting fraud and illegal activity is one such protected action when it is done in good faith. Whistleblower protections mean you cannot be retaliated against, which includes being wrongfully terminated, facing harassment in the workplace, or being demoted.
Unfortunately, even though it is illegal, employers may still engage in retaliatory behaviors. It’s important to protect your rights, including by ensuring that the claims you are making are based on reasonable suspicion. An attorney can help with this and protect your rights if you are retaliated against.
FAQs
Medicare fraud is investigated and prosecuted mostly by the Office of Inspector General’s (OIG) Medical Fraud Contract Units (MFCUs) in all states, including Florida, as part of the state’s attorney general’s office.
The OIG is part of the U.S. Department of Health and Human Services (HHS). Medicare and private healthcare fraud is also investigated by the Federal Bureau of Investigation (FBI), which works with other parties, including healthcare insurance groups and the Center for Medicare and Medicaid Services (CMS).
There are several ways to report Medicare fraud in Florida, including by calling the Medicare toll line, calling the tip line for the HHS, or calling the HHS-OIG directly. The HHS-OIG also has options for mailing or facing the complaint or by submitting it online. Both the general public and employees in the healthcare industry can report Medicare fraud. This includes healthcare providers, patients, and individuals that are receiving Medicare benefits.
The main difference between Medicare fraud and Medicare abuse is the circumstances in which the wrongdoing occurs and the individual’s awareness and intention to commit a crime.
Medicare abuse occurs when the Medicare program suffers financial loss because of a medical provider’s negligence, such as by overcharging patients or performing unneeded procedures. Medicare fraud occurs when a medical provider knowingly and intentionally submits false claims to Medicare for services not rendered or engages in kickbacks and illegal referrals.
Yes, a Medicare whistleblower can remain anonymous. Unfortunately, failing to give any identifying information when reporting the fraud to the HHS-OIG can make it difficult for the agency to investigate the claim.
It also cannot consider the report as a whistleblower case, as they do not know the reporter is an employee. Working with a whistleblower attorney can help you understand how to protect your interests and understand your protections against retaliation as an employee.
Navigating a Medicare Fraud Claim and Protecting Your Rights
Health care workers and those in the medical field, or those in billing departments may also sometimes witness firsthand these fraudulent practices. If you notice Medicare billing fraud, either because you are victim of fraud or because your employer is asking you to do illegal things, you may have the ability to bring forth a False Claims Act lawsuit and potentially receive a reward for speaking up. The Boca Raton Florida Medicare fraud lawyer at the Law Offices of Gary A. Costales, P.A., may be able to help you if you believe you have been a victim of Medicare fraud or witnessed Medicare fraud take place. You may even be able to receive a reward for speaking up under the False Claims Act.
