Atlanta Lack of Medical Necessity
Under federal law, Medicare will only reimburse for items or services deemed “reasonable and necessary” to diagnose or treat a condition. Health care providers must make a determination of medical necessity before ordering tests or treatment, otherwise they should not submit a claim to Medicare for reimbursement.
Despite this law, millions of false claims are submitted annually for unnecessary or frivolous procedures and tests. Many doctors fail to adequately document the medical necessity, and some might even fabricate records to support their billing.
At Stacey Evans Law, we help the government fight waste and fraud by representing whistleblowers with evidence of health care fraud. Please reach out to our law firm today to learn more about what you can do.
The Dangers of Unnecessary Care
Unnecessary medical procedures are a threat to our health care system. First, many patients can suffer injury if they are given treatment they do not need. Imagine someone receiving a prescription to treat a condition they don’t even have. Because side effects are common, they might end up sicker after taking the pills than before. Some medical procedures, like surgery, are inherently risky and patients could be severely injured—all when they did not need the care in the first place.
Second, our nation’s healthcare system becomes strained when too many unnecessary procedures are performed. Patients requiring legitimate surgery must wait weeks to finally get an opening, which can compromise their health and wellbeing.
Third, the nation’s insurance programs—in particular Medicare—are stressed. Unnecessary care costs roughly $1 billion annually, possibly quite a bit more. Medicare funding is a fraught political issue, and fraud drains money from the program which could go to legitimate health care needs.
Blow the Whistle on Unnecessary Medical Care
Whistleblowers are those individuals with information about health care fraud who take their information public. These people might be medical providers, paraprofessionals, or billing clerks with evidence that services are being billed without medical necessity.
You can fight fraud by filing a whistleblower lawsuit under the federal False Claims Act. These civil suits impose monetary penalties on violators and claw back any fraudulently obtained money. Our clients can often receive a portion of the proceeds, and the law provides protections against retaliation.
Speak with an Attorney at Stacey Evans Law Today
Our Atlanta health care fraud attorneys can meet to review what you know about suspicious billing activity. If necessary, we can begin documenting your case and explain your rights should you go forward with a False Claims Act lawsuit or seek whistleblower protections. Reach out to schedule a free consultation call with an attorney.
