Because health care fraud in the Medicare and Medicaid programs is such a huge problem, this week our whistleblower lawyer blog writers (former federal prosecutors who are now whistleblower attorneys) begin a series of posts on “Lessons from Health Care Fraud in Medicare and Medicaid.”
We will discuss how whistle blowers in the medical services profession have been important resources in revealing and stopping health care fraud in hospitals, nursing homes, physicians’ practices, and the pharmaceutical or drug industry. We also discuss how the new IRS Whistleblower Rewards program may apply to unlawful referral arrangements involving hospitals or other medical facilities.
You may be surprised that more than 70% of the federal government’s recoveries in fraud cases are in health care fraud cases affecting Medicare and Medicaid. Many health care fraud cases have addressed over-billing or up-coding, fraudulent cost reporting, and billing for services not provided. Medicare, Medicaid, Tricare and Champus are some of the federal programs affected.
The government also sometimes views the failure to furnish the required “quality of care” in nursing homes as fraudulent, which is encouraging to anyone who believes in caring for the elderly with dignity. Nursing home fraud and abuse, or neglect of nursing home patients, makes any decent American citizen’s blood boil.
Unlawful referral arrangements involving hospitals or other medical facilities and doctors can be considered fraudulent. These referral agreements can trigger tax liability that makes the new IRS Whistleblower Program that we have written about extensively even more important in the effort to combat health care fraud in medicine.
Please stay tuned to our series on “Lessons from Health Care Fraud in Medicare and Medicaid.”