Medicare Fraud At Hospitals

It is often impossible for authorities to detect Medicare fraud at hospitals without the help of whistleblowers. It is estimated that improper billing practices and other types of hospital fraud cost American taxpayers billions of dollars every year.

If you choose to blow the whistle on hospital fraud, you may be able to help recover money stolen from U.S. taxpayers and, in return, obtain a financial reward for your efforts. Our attorneys will sit down with you, review the facts of your case, and help you determine if you can file a lawsuit under the qui tam provision of the False Claims Act.

Do you have knowledge of a hospital or hospice submitting false claims to the government? Contact our qui tam attorneys today to learn more about the important role whistleblowers play in reporting fraud.



Who Can Blow the Whistle on Hospitals?

Any current or former employee of a hospital, nursing home, hospice, or other healthcare organization who has knowledge of overbilling, the payment or receipt of illegal kickbacks, or other schemes to defraud Medicare and Medicaid may be able to file a whistleblower lawsuit. In addition, independent contractors, consultants, and other individuals who have knowledge of healthcare fraud at hospitals may also be eligible to take legal action and receive a monetary reward for their efforts.

These types of qui tam cases may involve the following types of professionals:

  • Hospital, nursing home, and hospice administrators
  • Doctors, nurses, and physician assistants
  • Benefit administrators
  • Accountants
  • Benefit consultants
  • Medical billing specialists
  • Medical coding specialists
  • Coding supervisors


Qui Tam Lawsuits: Types of Fraud

Common examples of fraud known to occur at hospitals, nursing homes, and other healthcare organizations include:

  • Billing for medical services that were not provided to patients
  • Billing for supplies that were never actually purchased or used
  • Admitting patients to hospitals, hospices, and nursing homes who do not meet the eligibility requirements of Medicare or Medicaid
  • Upcoding, which involves manipulating billing codes to bill Medicare or Medicaid for a more expensive procedure or test
  • Unbundling, which involves related procedures or composite lab tests that were performed together and should be billed using a single billing code. Instead, they are billed separately to obtain higher levels of compensation from Medicare or Medicaid
  • Paying kickbacks to doctors and other healthcare providers in exchange for referring patients to the hospital
  • Knowingly mischaracterizing medical services so that they are reimbursed by Medicare and Medicaid
  • Billing Medicare or Medicaid for services performed by medical residents without the required participation of a supervising teaching physician
  • Overcharging for the costs of ambulance services


Additionally, our qui tam attorneys handle cases involving hospitals that submit false information in their annual cost report. Hospitals that participate in Medicare Part A must submit an annual cost report to the federal government detailing the costs of various procedures performed at the hospital, as well as the costs of medical devices and equipment purchased during the year.

In submitting this report, the hospital must certify that it complies with federal laws and regulations that apply to the healthcare industry and certify that the cost information contained in the report is truthful and accurate. It is a violation of federal law for a hospital to knowingly inflate costs described in the annual cost report.

If you have knowledge about a healthcare organization that has submitted false or misleading information to Medicare, our qui tam attorneys may be able to help you receive a financial reward for reporting the fraudulent conduct to the federal government.