Healthcare fraud is a costly crime that affects both individuals and businesses alike. Unfortunately, scams like upcoding, double billing, and kickbacks are significant in the industry, costing the nation billions of dollars each year. It can increase taxes, expose people to unnecessary medical procedures and raise insurance premiums.

The best way to fight fraud is to expose the individuals and organizations committing these crimes. Whistleblowers play a major role in stopping healthcare fraud and may be eligible for a reward by bringing a case under the federal False Claims Act. However, identifying and reporting fraud is not always easy. This article gives you what you need to know about blowing the whistle on healthcare fraud.

Who Commits Healthcare Fraud?

Healthcare fraud is committed by both medical professionals and organizations. These include:

  • Hospitals
  • Home Health and Hospice Organizations and Providers
  • Laboratories and Diagnostic Testing Facilities
  • Managed Care Organizations
  • Medical Device and Durable Medical Equipment (DME) Manufacturers and Distributors
  • Pharmaceutical Organizations
  • Medical Providers
  • Skilled Nursing Facilities

Types Healthcare Fraud

There are many kinds of fraudulent activities that could occur in the healthcare sector. Some examples of frauds and scams in the healthcare industry include:

  • Violation of laws prohibiting kickbacks and certain financial arrangements
  • Upcoding
  • Risk adjustment fraud by Managed Care Insurance Companies
  • Unbundling of services or procedures
  • Billing for services not provided
  • Billing for services that are not medically necessary
  • Billing for unlicensed personnel
  • Billing for unauthorized locations
  • Electronic health record (EHR) fraud
  • Off-label marketing of prescription drugs
  • Defective products and manufacturing violations
  • Discount/rebate and other pricing fraud
  • Clinical trial/FDA fraud
  • Compounding pharmacy fraud

What To Do if You Spot Healthcare Fraud

If you suspect healthcare fraud or have seen signs that indicate fraudulent activity, you should document your complaint in writing with as much detail as possible. Keep documentation as objective as possible, stating only facts and actions. Then, carefully monitor the situation for paperwork, emails, texts, transactions, or conversations that could prove a violation of the False Claims Act or other compliance regulations.

The next best course of action is to consult a law group with attorneys who specialize in blowing the whistle on healthcare fraud. They can help you determine if you have a good case and what would be the best course of action.

Help Blow the Whistle on Healthcare Fraud

The dark side of the healthcare industry has immense impacts on our society. Consumers, healthcare systems, and government entities suffer the consequences of healthcare frauds that lead to diminished patient care, mistrust in the healthcare system, and misappropriation of publicly funded healthcare.

Our goal at DJO is to expose healthcare fraud wherever and whenever possible. We work with individuals to gain information, build a case, and fight for taxpayers’ justice. In doing so, we can protect the vulnerable and make the world a safer place.

If you suspect healthcare fraud in your organization, please contact us. DJO is comprised of a highly experienced team of whistleblower experts, lawyers, and even former whistleblowers, who strive to deliver the highest monetary reward for brave individuals who have valuable information that can expose fraud. If a whistleblower’s lawsuit is successful, the reward can be between 15% to 25% of the funds recovered. The False Claims Act also offers whistleblowers protection against job retaliation or wrongful termination.

Do you have valuable information that can help bring fraud to light? Speak to our experts today.

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