Billing For Care Not Provided
Many Floridians rely on Medicare to cover designated medical expenses, and health care providers who offer services recoup their fees through this federal health insurance program. Unfortunately, there are some physicians and practices that take advantage of the system. According to the Centers for Medicaid & Medicare Services (CMS), around $30 billion is improperly paid for Medicare services every year, an amount that falls on taxpayer shoulders. One tactic used is billing for care not provided, which essentially leads to a windfall for the practitioner.
To discourage Medicare fraud and recover funds, the U.S. government allows individuals to take action as whistleblowers under the Federal False Claims Act (FCA). You could be eligible for a reward by uncovering fraud, and our team at Guttman, Freidin & Celler can assist with your case. Please contact our firm to schedule a free case review with a Florida Medicare fraud attorney, and check out some information on billing for care not provided.
Billing Practices and Medicare Fraud
Though there are many specific types of fraud, they all involve the use of deception to obtain money or something of value. Medicare fraud involves submitting false information to CMS in connection with reimbursement. Billing for services not delivered and care not provided is one of the most common schemes. A health care provider cheats Medicare through such tactics as:
- Falsifying invoices for treatment;
- Creating documentation for medications that were not subscribed; and,
- Preparing bills for procedures or lab screenings not performed.
Billing for care not provided is a common form of Medicare fraud in assisted living and elder care facilities, where the patients may be unable to testify because of advanced age or a dementia-related medical condition.
Remedies Under FCA
This federal statute establishes a cause of action known as qui tam, in which a whistleblower sues the fraudster for misconduct on behalf of the government. If you have knowledge about Medicare fraud based upon billing for care not provided, you may qualify as a qui tam plaintiff to recover funds for CMS. FCA motivates individuals in your position to come forward so that the government can recover misappropriated funds. A Medicare fraud attorney can provide specifics, but note that:
- Your share is 15 to 25 percent of the total if officials opt to intervene, which essentially means the government takes over the lawsuit.
- You could receive 25 to 30 percent of the total amount recovered by CMS if the government does not intervene.
A defendant owed the government three times the amount of the losses sustained by CMS, so the total amount at stake could be in the millions.
Contact a South Florida Medicare Fraud Lawyer Right Away
Bill for care not provided affects the US as a whole, which is why whistleblowers are incentivized to come forward regarding Medicare fraud. To learn more about your remedies, please call Guttman, Freidin & Celler at 800.654.8281 or go online to set up a no-cost consultation at our Miami offices. We can explain how the laws apply to your case after reviewing your unique circumstances.