Medicare Advantage Risk-Adjustment Fraud

Medicare Advantage plans commit fraud by submitting inaccurate risk-adjustment data for payment. As a whistleblower, you can put an end to these fraudulent practices and be rewarded for your efforts.

What Medicare Fraud Looks Like

The health care fraud committed by Medicare Advantage and PACE plans can take several forms:

  • Upcoding – With upcoding, fraud is committed by exaggerating the illness of patients. With a more serious diagnosis code, the facility can collect more money per plan member each month.
  • Chart Mining – Reviewing charts to upcode diagnoses and look for new risk adjustment claims.
  • Incentivizing upcoding – Encouraging doctors and other healthcare providers to upcode member diagnoses or list diagnoses that appear on the member’s problem list but are not illnesses they were treated for that year.

Upcoding is a major issue in the healthcare industry. It costs taxpayers millions each year because of the fraud committed against government funded programs intended to help the sick in need.

If you have information about Medicare fraud, please call (845) 383-1728 today to speak about your potential whistleblower case.

Help from a Medicare Fraud Attorney

Even if you have seen these practices in action, it can be difficult to know what to do about it. Many employees fear for their job if they decide to blow the whistle on fraudulent practices. There are many protections in place to prevent employer retaliation against whistleblowers.

And with the help of an experienced Medicare fraud lawyer like James Ratner, you can navigate the sometimes intimidating waters of your case without worry.

Medicare fraud whistleblowers can be awarded a percentage of the money recovered in whistleblower cases. If you have information about Medicare fraud that cost the government millions of taxpayer dollars, please contact James T. Ratner for your confidential consultation with an experienced Medicare fraud attorney. Serving clients in New York and nationwide.

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