Health care fraud is on the rise. According to Justice Department statistics, federal prosecutors filed 377 health care fraud cases during the last fiscal year. That number represented a three percent hike over the number of cases pursued by prosecutors during the previous fiscal year.
The FBI estimates that US taxpayers foot the bill for approximately $80 billion in improper payments to Medicare and Medicaid annually.
Some of the most common types of Medicare or Medicaid fraud are:
- Medical billing fraud: This can involve double billing both Medicare and a private insurance company for the same medical procedure, billing for brand-name drugs instead of generic drugs, manipulating cost reports to increase Medicare reimbursement, and billing by physicians who are not licensed to provide Medicaid or Medicare
- Unnecessary testing: A common form of fraud committed by hospitals is to provide false diagnoses in order to encourage patients to undergo unneeded medical procedures
- Up-coding: A company can inflate medical bills by intentionally using an incorrect code when indicating the type of procedure that was performed
- Durable medical equipment fraud: The elderly are at heightened risk of medical fraud because of their greater need for medical equipment such as wheelchairs and oxygen supplies
- Off-label marketing of medication: Doctors are sometimes encouraged by pharmaceutical representatives to illegally prescribe drugs for unapproved uses
- Pharmacy fraud: Some pharmacists repackage and then illegally sell secondhand prescription drugs
- HIV infusion fraud: This type of fraud occurs when HIV infusion clinics provide unnecessary treatments and try to scam Medicare
Both the FBI and the Department of Health and Human Services have placed a greater emphasis in recent years on fighting health care fraud committed by hospitals, nursing homes, hospices, doctors, nurses, medical supply companies, and other private business owners. This includes providing financial incentives for whistleblowers who report fraud. As a result, many Qui Tam and false claims cases involve whistleblowers reporting critical information about Medicare or Medicaid fraud.
If you have acted in conscientious objection to health care fraud in New Jersey or Pennsylvania, or anywhere else in the United States, contact the law offices of Begelman & Orlow, P. C. today at 866-627-7052. We are one of the nation’s premier law firms in Qui Tam and false claims litigation.