Health Care Fraud

New York Lawyer Protecting the Rights of Whistleblowers Nationwide

Each year, the U.S. government spends billions of dollars providing health care to support taxpayers through the Medicare and Medicaid programs. These support services give older and low-income individuals the opportunity to receive medical treatment that they might otherwise be unable to afford. Medicare and Medicaid offer health care providers reimbursement and payment for the services they render, while requiring the patient to pay only a fraction, if any, of the costs. Unfortunately, these programs are increasingly subject to efforts to fraudulently manipulate payments for private gain. Whenever the government suffers financial losses as a result, there may be a claim. Knowledgeable whistleblower attorney James T. Ratner has represented people nationwide from his New York office in their efforts to expose health care fraud. He has 18 years of experience and is ready to handle any potential qui tam case.

The U.S. Government and Health Care Fraud

Although health care fraud is an increasing problem in the United States, it is rarely exposed in a public fashion. Instead, it is often disclosed by a small group of individuals who may come forward to make a claim on behalf of the government, alleging that it has been defrauded by medical providers or billing companies.

These types of claims are known as qui tam actions, and they can be brought under the False Claims Act, which establishes liability for knowingly making a false claim to the government for payment. The False Claims Act has long been concerned with fraudulent billing practices, but in recent years the Patient Protection and Affordable Care Act (the recent health care reform law) has made it even easier for qui tam plaintiffs to bring claims against medical and health care providers. This law expanded the scope of the FCA to include liability for failures to refund overpayments made by Medicare or Medicaid, and to presume that any violation of the Anti-Kickback Statute is also a violation of the FCA.

Identifying Misconduct Regarding Medicare and Medicaid

Health care fraud can take many forms, of which the most widespread are overbilling and upcoding. These occur when a medical provider attempts to bill Medicare or Medicaid for more than the service that was actually provided. Thus, for instance, a doctor or provider may bill for a service that was not actually rendered to the patient, such as a test that was not really performed. In more subtle circumstances, the provider may exaggerate the service provided, such as billing for more time with a patient than was actually given. Moreover, a provider may make up non-existent patients and bill the government for all of the services allegedly rendered to these individuals.

Another common form of health care fraud is kickbacks, which are payments made to any sort of referral source in exchange for the referral of patients who will be paid for by Medicare or Medicaid. Kickbacks can include such obvious payments as bonuses or percentages of fees ultimately received from such patients, or they can be more insidious and difficult to detect through their characterization as “speakers fees” or consultation fees. These types of claims are often almost impossible to prove without the assistance of a whistleblower who has been involved in or witnessed their payment.

Other examples of health care fraud include providing patients with services that are medically unnecessary and then billing Medicare or Medicaid for such services, or billing procedures in an “unbundled” manner. This means that a doctor will bill the government for each component of a procedure or a test because the physician knows that it is more expensive to bill parts of the service separately than to bill it as a comprehensive medical examination.

Contact an Experienced Qui Tam Attorney in New York

Making the decision to expose corruption or fraud by health care providers who bill Medicare or Medicaid can be daunting. However, it is important to know that any practice that intentionally causes the government to pay more than it should for a product or process is a form of fraud and is actionable under the False Claims Act. If you have recently witnessed any type of misconduct against the government, such as health care fraud or pharmaceutical fraud, you can seek advice from New York lawyer James T. Ratner on your potential legal options. He represents clients throughout the U.S. Call our office at (845) 383-1728 or contact us online to set up a free consultation.

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