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Healthcare Whistleblowing - Upcoding

Hospitals are vital places in our society where medical miracles can cure illnesses that once spelled certain doom for those who contracted them. Unfortunately, this fact does not mean they aren’t also breeding grounds for corruption, illicit financial activity and naked fraud. In fact, as much as 10 percent of the budget for Medicare has been estimated to be wasted away on fraudulent billing. If you have reason to suspect a hospital or doctor is utilizing financial fraud to bilk more money from Medicare or from other insurance companies, contact the white-collar crime experts at Altman & Altman LLP today.

What Is Upcoding?

There are many different means in which a healthcare entity – such as a hospital, small doctors’ office, long-term care facility or senior care facility – can defraud the federal government or private insurance companies in order to make more money through reimbursements.

One common means of fraud occurring in healthcare is a process called upcoding – where a healthcare facility will perform one medical procedure on a patient, but bill their insurance company or Medicare for a must more expensive procedure that actually wasn’t performed. This allows the healthcare facility to claim more money in reimbursement, earning them a significant margin, since the procedure they actually performed was likely far less expensive than the procedure they billed for.

Upcoding doesn’t only need to occur in actual medical procedures, however. It can be done with upcoding the type of medication subscribed, falsifying the length of hospital or through embellishing the type and frequency of medical care given to a patient. But the important thing to remember is that upcoding occurs any time a healthcare facility knowingly and fraudulently makes a financial claim for services that were not rendered.

Whistleblowing Is a Protected Activity, Which Can Also Lead to Compensation

Upcoding, like other types of healthcare fraud, is a harmful activity which has a negative impact on the healthcare industry as a whole. The federal government actively seeks help from private citizen whistleblowers to help lead to the finding out of healthcare facilities engaged in this practice and in other types of healthcare fraud.

Under the False Claims Act, whistleblowers that lead to a successful penalty waged against a healthcare facility can be eligible to receive a huge payday – as much as 30 percent of the monetary penalty that is brought against the entity, which can amount to significant amounts of money for the whistleblower.

However, there are certain stringent restrictions to filing a successful whistleblowing claim. For one, you must have evidence that the federal government does not currently possess, or would otherwise be able to find out through public means. Your information must lead to a successful finding of fraudulent activity, and in order to secure an award it must be a sizable penalty of at least $1 million.

The experienced white-collar crime attorneys at Altman & Altman LLP have over 50 years of experience assisting whistleblowers, and we are here to help you if you wish to come forward as well.

We’ll Help You Take a Stand

The federal government can’t allocate the proper resources to investigate every case of fraud that comes their way, nor can they gather crucial evidence to make such accusations stick. This is why whistleblowers are so important and have helped the government collect many billions of dollars in penalties waged against fraudulent healthcare entities in the past.

However, they want whistleblowing cases to be neatly wrapped up and put together by the time they look at it, which means you’ll need a strong team of attorneys to ensure that your case is solid and the evidence is well established. We will know what financial information to look for and, if you are worried about being retaliated against or losing your job for providing such information, we may be able to file your whistleblower case anonymously, ensuring your privacy and protection.

Contact us online or call for a free consultation to go over the details of your case today at 617-492-3000 or toll-free at 800-481-6199. We are available 24/7.

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