Our New York Medicaid Fraud Lawyers are often asked to provide their insight and guidance to employees who want to blow the whistle on healthcare fraud. While there used to be a stigma of coming forward, events in recent years have shown that it pays to be a whistleblower. Not only does the employee-whistleblower shine a light on inappropriate activity and help society at large by doing so, if handled correctly there may be a significant benefit to the whistleblower too. This can be a tricky area. It is critical to speak with an experienced attorney before taking any steps. A misstep can be costly.
Over the past three years, New York State has recovered over 1.7 billion dollars in medicaid fraud. The efforts of whistleblower, private counsel and the Office of Medicaid Inspector General are helping to reduce fraud, abuse and waste. An audit was conducted of a business in Westchester County – the Abbott House in Irvington. According to the results of the audit, it was alleged that not all of the required information to support reimbursement claims under the Medicaid consumer program were kept. Over $250,000 was recovered as part of this audit. This is just one example of a recovery. Many other cases involve duplicate billing, improper kickbacks, benefits paid to ineligible individuals and payments made to ineligible providers.
If you are aware of any improper information and want to know your rights, call our office to speak with an experienced attorney on a confidential basis and learn your options and how we can help you. Below are some of most common examples of healthcare fraud:
1. “Phantom billing.” This occurs when a provider bills for medical services not actually performed.
2. “Upcoding.” This occurs when a provider bills for a more expensive service than the service that was actually provided to the patient. This can be difficult to uncover because of the overhwhelming number of medical codes.
3. “Unbundling.” This occurs when a provider bills for several services or procedures that should be combined into one billing.
4. “Duplicate billing.” Simply put, duplicate billing is the practice of billing twice for the same medical service.
5. “Kickbacks.” An unlawful kickback may involve giving or accepting gifts in return for medical services.
6. Dispensing generic drugs and billing for name brand drugs thereby obtaining an unfair profit.
7. “Providing unnecessary services.” Providing unnecessary services can include treating a patient beyond the time necessary to achieve the patient’s maximum health benefit.
This is not an exhaustive list and is only for illustrative purposes. If you are aware of these issues or other issues involving healthcare fraud, call us now at (800) 893-9645.
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