Atlanta Health Care Fraud Attorneys Supporting Georgia Medicaid and Medicare Whistleblowers
Health care fraud takes on many forms. Typically it involves health care providers submitting false claims for reimbursement to private insurers or government payers such as Medicare or Medicaid. Under this broad definition, health care fraud can be committed by many different types of providers in countless different ways.
Laws such as the federal False Claims Act and the Georgia State Medicaid False Claims Act allow people who uncover health care fraud at work to file whistleblower lawsuits on behalf of the government and recover any monies that were fraudulently obtained. As a reward, the whistleblower gets to keep a portion of the monies recovered, as much as 30% in some instances.
The attorneys at Stacey Evans Law help whistleblowers in Atlanta and throughout Georgia file lawsuits under the False Claims Act and help the government recover money it has been defrauded out of. If you work at a medical facility or medical billing company and learn about fraudulent claims being submitted to Medicare or Georgia Medicaid, call Stacey Evans Law for advice and assistance in coming forward as a whistleblower. Our comprehensive Georgia health care fraud practice encompasses every type of health care fraud, including all these listed below:
Ambulance Fraud
Ambulance companies transport people to the hospital when it is not medically necessary and less expensive options could just as well safely transport the patient. Ambulance companies engaged in this fraud fail to get the required physician certification that an ambulance is medically necessary, or they enter into illegal kickback schemes with medical facilities to provide services that aren’t necessary and then bill Medicare or Medicaid for reimbursement.
Billing for Care Not Provided
This type of health care fraud occurs when hospitals and clinics charge Medicare for services or procedures they never actually provided.
Bill Padding
Bill padding occurs when doctors, hospitals, nursing homes or other providers bill for more services than are truly needed for the patient, such as ordering routine blood work for every Medicare patient who walks through the door regardless of the reason for the visit.
Cost Report Manipulation
Medicare and Medicaid both require certain health care providers, such as hospitals, nursing homes and home health agencies, to submit cost reports in order to receive payment. Fraud occurs when these providers manipulate the cost reports to include costs that are not apportionable to their Medicare patients or when they combine Medicare and non-Medicare patients in the cost basis. Cost report manipulation can also occur by inflating costs or including noncovered services and supplies in the report.
Home Healthcare Fraud
Medicare reimburses home healthcare providers who provide certain covered services to homebound patients, such as skilled nursing care, physical therapy, occupational therapy or speech therapy. Home health agencies commit fraud when they seek reimbursement for non-covered services or services to patients who don’t meet the definition of “homebound,” or when they don’t provide services according to a doctor-authorized plan of care.
Kickbacks for Referrals
The Stark Law and the Anti-Kickback Statute prohibit drug companies from paying doctors or hospitals or giving them financial incentives to prescribe their drugs. Doctors also cannot refer patients to other facilities such as testing centers or labs that the doctor has an ownership interest in. Doctors and pharmaceutical reps can get quite creative in their attempts to evade these laws, and the government relies on whistleblowers to come forward and expose these illicit scams.
Off-Label Marketing
It is not uncommon that a drug approved for one use will later show up having unanticipated benefits in other areas, such as a blood pressure drug helping with weight loss. Nothing necessarily prevents a doctor from prescribing medication for off-label use, but when pharmaceutical companies promote their drugs for off-label use, they are committing fraud by marketing their drugs for uses that were not FDA-approved as safe and effective for off-label use.
Pharmacy Fraud
Pharmaceutical fraud can include paying doctors and hospitals kickbacks to prescribe their medications, actively marketing their drugs for off-label uses the medications were never tested or approved for, selling adulterated pharmaceuticals to Medicare or Medicaid, or hiding the drug’s best price when charging Medicaid.
Upcoding
Upcoding fraud occurs when health care providers submit claims for reimbursement to Medicare using CPT codes for services that are more expensive than the ones actually provided, such as billing for services provided by the PA as though they were performed by the doctor, or coding for a complete set of x-rays when only one view was taken.
Unbundling
Unbundling refers to breaking apart a procedure into every possible billing component instead of submitting one claim for reimbursement based on the correct code for the procedure. Imagine if you went to buy a computer and were charged for every single component inside the CPU instead of one price; you would wind up paying much more. The same happens when health care providers unbundle their services when billing Medicare or Medicaid for a single procedure.
Other Forms of Health Care Fraud
Some of the many other types of health care fraud cases our law firm handles include:
- Hospice Care Fraud
- Hospital Fraud
- Laboratory Fraud
- Lack of Medical Necessity
- Medical device fraud
- Nursing Home Medicare Fraud
- Outlier Payments
- Prescribing Unnecessary Medications
- Research Grant Fraud
- Retention of Overpayments
- TARP and Federal Stimulus Fraud
- Waiving Medicare Co-Pays
Contact Stacey Evans Law for Help Blowing the Whistle on Health Care Fraud in Georgia
You can help the government pursue a case against health care providers defrauding Medicare, either as the lead plaintiff in a lawsuit or participating in a case with the Attorney General. Either way, you can be rewarded for your courage and efforts by receiving a portion of monies recovered. An experienced health care fraud law firm can assist you in filing a lawsuit, conducting settlement negotiations, or securing a judgment in court. For help with Medicare or Medicaid fraud in Georgia, call Stacey Evans Law in Atlanta at 404-850-6750. Stacey Evans Law is the law firm to count on for determined, dedicated and dogged assistance holding health care providers accountable for fraud against the government.
