Healthcare fraud costs taxpayers an estimated $100 billion each year.  Illegal Kickbacks, Upcoding, Double Billing, False Coding, and fraudulent mischarging of health care services are just a few ways that fraudulent medical providers are able to defraud Medicare, Tricare, the Veterans' Administration (VA), and other government services out of billions of dollars.  Heroes including health care administrators, doctors, nurses, and therapists are stepping forward and blowing the whistle on Tricare, the Veterans' Administration (VA), and Medicare billing fraud including manipulation of outlier payments to Medicare, kickbacks, upcoding, or bill padding. 

If you are a healthcare professional that is aware of fraud, please become a Tricare, Veterans' Administration (VA), Medicaid, or Medicare Whistleblower.  To learn about how to file a Tricare, Veterans' Administration (VA), or Medicare Fraud Qui Tam Lawsuit, feel free to contact Medicare, VA, Tricare Fraud Whistleblower Lawyer Jason Coomer via e-mail message or our submission form about a potential upcoding, illegal kickback, bill padding, double billing, or billing fraud qui tam lawsuit. 

Health Care Fraud Upcoding Whistleblower Law Suits (Medicare, VA, and Tricare Upcoding Qui Tam Whistleblower Claims)

Upcoding occurs when a medical service provider intentionally and fraudulently upcodes services to obtain a higher reimbursement than one that is entitled to for the service that was actually provided.  In both the Medicare and Medicaid systems a set of billing codes is used by healthcare providers to bill for services. These codes are known as the Healthcare Common Procedure Coding System (HCPCS). A service provider that intentionally uses a higher paying code to fraudulently reflect that a more expensive procedure or device was involved in the patient’s treatment than actually was used or was necessary.  A pattern of intentional upcoding treatment can result in large profits for the healthcare provider, but also cost taxpayers millions of dollars.

Upcoding fraud is typically hard to catch without the help of persons with inside information because that Healthcare Common Procedure Coding System (HCPCS) codes are billed electronically and can easily slip through the system.  Therefore unless the upcoding is caught through a random audit (approximately 2% of the claims per year are audited), it is up to insiders, informants, heroes, and health care professionals to catch fraudulent upcoding.

Another type of coding fraud is “unbundling”, where bundled related procedures or composite lab tests are run together, but billed separately by the lab or healthcare provider to obtain more compensation.  These types of billing fraud also allow healthcare providers and labs to make higher profits by bilking Medicare, Medicaid, and taxpayers out of millions of dollars.  These unbundling fraud schemes are also hard to detect without someone that is familiar with the codes and billing.

  Qui Tam Whistleblower Plaintiffs have received over $1 Billion in Awards of the over $12 Billion in Recoveries for Exposing Fraud Against the United States Government (Qui Tam Plaintiff Whistleblower Claims)

Medicaid, Tricare, Veterans Administration, Hospice, and Medicare Whistleblowers that provide original source information of schemes to fraudulently take money from our United States government including upcoding, double billing, bill padding, unbundling, and charging for services never provided may recover a portion of the proceeds recovered on the government's behalf.  Since 1986, relators have recovered over $1 billion for helping expose fraud against the United States government. 

Below is an excerpt from the False Claims Act explaining what types of awards qui tam whistleblowers may recover for being the "original source" of information that is used to successfully expose fraud against Medicaid, Tricare, Veterans Administration, Hospice, Medicare, or another subdivision of the United States Government and recover money from the parties committing the fraud. 

(d) AWARD TO QUI TAM PLAINTIFF

(1) If the Government proceeds with an action brought by a person under subsection (b), such person shall, subject to the second sentence of this paragraph, receive at least 15 percent but not more than 25 percent of the proceeds of the action or settlement of the claim, depending upon the extent to which the person substantially contributed to the prosecution of the action. Where the action is one which the court finds to be based primarily on disclosures of specific information (other than information provided by the person bringing the action) relating to allegations or transactions in a criminal, civil, or administrative hearing, in a congressional, administrative, or Government [General] Accounting Office report, hearing, audit, or investigation, or from the news media, the court may award such sums as it considers appropriate, but in no case more than 10 percent of the proceeds, taking into account the significance of the information and the role of the person bringing the action in advancing the case to litigation. Any payment to a person under the first or second sentence of this paragraph shall be made from the proceeds. Any such person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys’ fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.

(2) If the Government does not proceed with an action under this section, the person bringing the action or settling the claim shall receive an amount which the court decides is reasonable for collecting the civil penalty and damages. The amount shall be not less than 25 percent and not more than 30 percent of the proceeds of the action or settlement and shall be paid out of such proceeds. Such person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys’ fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.

Since amendments were made to the Federal False Claims Act in 1986, citizens that have filed suits on behalf of the federal government against government contractors that have participated in defrauding the government have regained over $12 Billion for taxpayers as well as have collected over $1 Billion in qui tam whistleblower awards. 

Medicare and Healthcare Fraud Law Suits (Qui Tam Claims)

HEALTH CARE FRAUD CASE NETS RECOVERY OF $1.7 BILLION

HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company) and HCA subsidiaries agreed to pay the United States over $1.7 Billion including $631 million in 2003 for civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs. In 2000, HCA subsidiaries pled guilty to substantial criminal conduct and paid more than $840 million in criminal fines, civil restitution and penalties.  HCA will pay an additional $250 million to resolve overpayment claims arising from certain of its cost reporting practices.  In total, the government will have recovered $1.7 billion from HCA.

This Qui Tam settlement resolved fraud allegations against HCA and HCA hospitals in nine False Claims Act qui tam or whistleblower lawsuits pending in federal court in the District of Columbia. Under the federal False Claims Act, private individuals may file suit on behalf of the United States and, if the case is successful, may recover a share of the proceeds for their efforts. Under the HCA settlement, the whistleblowers will receive a combined share of $151,591,500.00.

http://www.usdoj.gov/opa/pr/2003/June/03_civ_386.htm

Government Contractor Fraud Qui Tam Whistleblower Lawsuit Information (False Claims Act Whistleblower Qui Tam Action Information)

For more information on Medicare Fraud, Tricare Fraud, Medicaid Fraud, Defense Contractor Fraud, Off Label Fraud, Road Construction Fraud, and other types of False Claims Act Whistleblower Claims, please go to the Qui Tam, Whistleblower, and Federal Federal False Claims Act Information Center.