Health Care Fraud

California Health Care Fraud Attorneys

When a company or individual defrauds a government health care program or an insurer, health insurance fraud has been committed. There are many ways that this can be achieved, and individuals are actively engaged in seeking new ways to circumvent these laws. Fraud damages can be recovered through the False Claims Act, which is common under the qui tam provision that rewards an individual for being a relator or “whistleblower.”

An estimated $60 billion a year is what the FBI says costs American tax payers for health care fraud. Roughly $2.5 billion of this amount was recovered through False Claims Act cases in the Fiscal Year 2010. Most of them being filed under qui tam provisions. Throughout 2010, whistleblowers were paid a total of $307,620,401.00 for their part in bringing the cases forward.

Types of Health Care Fraud

There are a few different schemes that are used to defraud the American health care system:

Billing for services not rendered

Commonly known as billing Medicare for a service that did not occur. Forged signatures of individuals enrolled in Medicare, along with the use of bribes (kickbacks) to corrupt medical professionals.

Upcoding of services

Commonly known as the billing of services that are more costly than what was actually rendered.

Upcoding of Items

Commonly known as the billing of items that are more costly than what was received by a patient.

Duplicate Claims

The provider does not submit the exact same bill, while changing small portions such as the date in order to charge Medicare twice for the same service that was rendered. This is done in an attempt to be paid twice.

Unbundling

Bills for a particular service are submitted in piecemeal, that appear to be staggered out over time. These services would normally cost less when bundled together, but by manipulating the claim, a higher charge is billed to Medicare resulting in a higher pay out to the party committing the fraud.

Excessive Services

Common when Medicare is billed for a service greater than what was required. Medical equipment and services are included.

Unnecessary Services

Common when claims are filed for care that does not apply to the condition of the patient, depending on the issue the patient is having.

Kickbacks

Items of value, including money, vacations, corporate sponsorships or other lavish gifts are used to persuade medical professionals into using specific medical services that is identified in the previous categories of health care fraud.

It is imperative to have an aggressive and experienced Orange County criminal defense attorney from Corrigan | Welbourn | Stokke.
Corrigan | Welbourn | Stokke is located in Orange County and represents surrounding areas including Newport Beach, Westminster, Santa Ana, and Fullerton. Call Corrigan | Welbourn | Stokke today to schedule a free case evaluation.