Medicare is a federal health care program that is intended to make medical care and prescription drugs more affordable for long-term Social Security Disability recipients and individuals who are age 65 and older.

While Medicare is a vital program upon which millions of Americans depend for vital health care services and life-saving drugs, annually, the program suffers billions of dollars in losses due to acts of fraud.

Examples of Medicare Fraud

The most common type of government fraud is Medicare fraud. Here are five examples of Medicare fraud:

Overbilling for services: It is illegal for hospitals and other healthcare organizations to charge twice for a service or procedure that was only performed once.

Billing for services that were not provided: Also known as phantom billing, this is one of the most common examples of Medicare fraud that occurs when a hospital or healthcare organization bills Medicare or Medicaid for tests or services not performed.

Manipulating billing codes or up-coding: This occurs when a hospital or other healthcare organization fraudulently alters diagnosis or treatment codes to receive higher reimbursements from Medicare or Medicaid.

Physician kickbacks and patient referrals: It is illegal for healthcare providers to make or accept payments for referring, recommending, or arranging for the purchase of items paid for by federally-funded programs. The healthcare organization making or receiving the bribes can be held liable for damages under the False Claims Act.

Billing for unnecessary services: Healthcare organizations may be subject to liability under the False Claims Act for billing for services or procedures that are not medically necessary, such as providing patients with unnecessary stent implants.

Whistleblowers and the False Claims Act

Whistleblower lawsuits involve many different examples of Medicare fraud at hospitals and healthcare organizations.

Common examples of Medicare fraud include billing for services that were not provided, billing of unnecessary services, misrepresenting dates of service, or providers of service, and paying kickbacks for patient referrals.

When a hospital or healthcare organization submits a fraudulent invoice to Medicare, it is essentially stealing from the American taxpayer and keeping the money for itself.

Thus, for purposes of calculating the amount that has been defrauded from the federal government, each individual invoice submitted to Medicare constitutes a separate “false claim.”

Under the False Claims Act, the government can obtain treble damages from the fraudulent employer. This means three times the amount of damages sustained by the government in addition to fines for each civil penalty.

The penalties are high but the misuse of government funds and taxpayer money is no small violation.

Filing a Whistleblower Lawsuit

Many times, current or former employees, such as an MRI or radiology technicians working at a healthcare facility or clinics, have first-hand knowledge of fraudulent Medicare billing.

If you believe that Medicare fraud may be occurring at your workplace, it is important that you speak with an experienced whistleblower attorney.

A whistleblower attorney will review the information that you have regarding the potential Medicare fraud and help you determine if a lawsuit should be filed. Your attorney can also protect you from retaliation and help you maintain your confidentiality during the whistleblowing process.