Attorney James Young explains how healthcare fraud is committed when providers bill for services that were actually not provided.
More often than you would believe, medical providers submit claims to health care plans and/or insurance companies for services and care that were never actually provided. Sometimes it is as simple as checking off an extra box or two on a superbill. Beyond a whistleblower, the only tool the government has to audit or oversee against this type of fraud is the required documentation relating to procedures performed. Beyond the fact that such documentation can also be faked, most of the time the fraudsters don’t even include it.
Billing for services and care not rendered often make for simple cases to present in court because the scheme is so basic that even half-asleep jurors can understand it. A nurse or biller is often on the frontline of such fraud. It is not ok to look the other way when you are asked to, or witness someone else, overbill for health care.
When someone steals from the government, they’re stealing from you. Speak to our Whistleblower Team and we’ll make sure your privacy is protected and you are rewarded for your honesty.