DJO Managed Care Fraud Whitepaper Cover

Managed care insurance fraud is an unfortunate reality contributes to rising healthcare cost, higher taxes with a staggering chain of impact.

It’s a scheme that costs the government and its taxpayers billions of dollars each year. We need to put a stop to exaggerated patient billing, upcoding, and inflated risk adjustment factor scores and you can help.

To learn more about deciding if you should blow the whistle–and what to expect if you do–download our guide for an in-depth look at the process and rewards.

DJO Managed Care Fraud Whitepaper Cover

The History of Managed Care

Before managed care, healthcare was financed by a fee-for-service system in which a physician would perform a service and charge the patient a fee. The patient would either pay for the service out-out-of-pocket or send the bill to their insurer for reimbursement. However, the fee-for-service lacked cost-efficiency. In response, the Nixon administration passed the Health Maintenance Organization (HMO) Act of 1973 to decrease costs for healthcare consumers through the establishment and expansion of HMOs. By emphasizing health maintenance, HMOs could prevent health problems before they developed and, thus, efficiently manage healthcare inflation, which was spiraling out of control in the fee-for-service system.

Unfortunately, over time, middleman coding companies, as well as dishonest Managed Care Organizations (MCOs) offering Medicare and Medicaid Advantage Plans, exploited this system by falsifying patient records and miscoding patient diagnoses in order to qualify for additional funds. Through schemes like upcoding, phantom billing, and inflated risk adjustment factor (RAF) scores, wrongdoers are able to game the system and steal from not only American taxpayers but also the millions of Americans who rely on these plans for care.

Managed care fraud is a crime against you, the government, and all the honest professionals in the medical field. It’s a major contributing factor to rising healthcare costs in the United States, and it must be stopped. We need to work together to protect the collective and report fraud in managed care whenever possible.

Working Collectively to Protect the Collective

Exposing fraud in managed care can help put a stop to rising healthcare costs, increased taxes, and diminished care. However, weighing the potential reward of doing the right thing with the potential risk of whistleblowing is not something that should be taken lightly. It’s important for potential whistleblowers to know there are protections that keep them safe from discrimination and retaliation by employers against employees for reporting fraud.

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Whistleblowers play a major role in the fight against corruption, fraud, and wrongdoing in managed care. These brave individuals have helped save millions in public funds and the integrity of our healthcare system. That’s why it’s important we continue to do what’s right and report fraud wherever, whenever possible.

For those considering blowing the whistle, consulting the right fraud attorney is an important first step. The right law group can help you keep you protected, guide you through the entire process, and help you earn a potential reward of up to 25% of what the government recovers for doing the right thing.

DJO Whistleblower Lawfirm whitepaper

The best way to fight fraud is to blow the whistle and expose the organizations and individuals committing these crimes. But the decision to blow the whistle is never easy. It requires careful determination and the right legal team to enact positive change. If you believe you’ve witnessed fraud in managed care and are considering becoming a whistleblower, download our guide for an in-depth look at the process, whistleblower protections, and the potential rewards for successful cases and learn more about:

  • The chain of impact 
  • Examples of fraudulent schemes
  • Weighing the pros and cons of becoming a whistleblower
  • Legal whistleblower protections
  • Evidence collection for a legal case

About DJO

For those considering blowing the whistle, consulting the right healthcare fraud attorney is an important first step. The right law group will have experts in different types of fraud so they can help you determine if you have a good case and what the best course of action is. 

If you are considering blowing the whistle, experienced healthcare fraud attorneys can help answer your questions and guide you through an otherwise arduous situation and work to earn you the monetary rewards you deserve.

Our Team is Here to Support You

We know that becoming a whistleblower is a significant undertaking and can be an arduous experience — our team is here to offer expertise and knowledge to guide you through the process.

The Daniel J. Ocasio Whistleblower Law Group exists to assist individuals in reporting fraudulent activity. With decades of combined whistleblower experience and more than 200 cases investigated and filed, our team has been involved directly with recouping hundreds of millions of dollars for US taxpayers. We firmly believe in doing what is right and will work alongside you every step of the way in support, as together, we deliver justice.

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Additional Resources

We want to help make people aware of what constitutes fraudulent activity, so they know when to come forward.
Here are some additional resources to help you identify and report managed care fraud.