About Managed Care Insurance Fraud

Exposing Fraud in Managed Care Insurance

Do you believe you’ve witnessed fraud in managed care? Managed care insurance fraud is an unfortunate reality, contributing to rising healthcare costs, and higher taxes with a staggering chain of impact. The best way to fight fraud is to blow the whistle, report managed care fraud, and expose the organizations and individuals committing these crimes. Examples of fraudulent schemes include:

  • Risk Adjustment Fraud (RAF)
    • Occurs when healthcare providers or insurers manipulate patient data to inflate their RAF scores and receive higher reimbursements from Medicare or Medicaid.
  • Medical Loss Ratio (MLR) Fraud
  • Healthcare Effectiveness Data & Information Set (HEDIS) Fraud
  • Enrollment Fraud and Dis-Enrollment Fraud
    • Enrollment Fraud is when an Insurance company enrolls a beneficiary into their Managed Care Plan outside of approved enrollment periods using erroneous or deceptive information to qualify a beneficiary under the term Special Enrollment Period. 

    • Dis-Enrollment Fraud is when a third party (Nursing Home, Assisted Living, Home Healthcare, etc.) switches a patient from a Managed Care Plan back to “Traditional Medicare” without  consent solely for higher reimbursement purposes. 

If you are considering blowing the whistle, experienced healthcare fraud attorneys can help answer your questions and guide you through an otherwise arduous situation. Contact us to set up a free and confidential consultation. If a whistleblower’s lawsuit is successful, the reward could be up to 25% of what the government recovers.

Working Collectively to Protect the Collective

Financial losses aren’t the only consequence as a result of managed care fraud. There’s also a human side to fraud in managed care. Innocent people become victims when dishonest Managed Care Organizations (MCOs) and middleman coding companies compromise an individual’s medical records by submitting falsified claims and miscoding patient diagnoses in order to line their pockets with additional funds. 

When these organizations and their employees upcode medical bills for Medicare and Medicaid patients, they cheat those healthcare programs of needed funds. Additional victims of managed care fraud are the employees and physicians who are forced or manipulated into participating in the company’s criminal activities. 

Fraud in managed care is a crime against the community, families, the government, and all the honest doctors across the medical field. It has a massive chain of impact that leads to rising healthcare costs, higher taxes, and reduced care.

Too often employees, including physicians, are forced or manipulated into participating in fraudulent billing practices and reporting MCO fraud can come with a lot of personal fear and anxiety. If you have been put into an impossible position – we can help. Learn more about how to protect yourself, your finances, and your practice while doing what’s right.

Some of the largest settlements to date have been:

WellCare Health Plans Inc.
Recovered by the Government
$ 0
CenterLight Healthcare
Recovered by the Government
$ 0
Recovered by the Government
$ 0

For these cases, millions in rewards have been paid to the whistleblowers that report MCO fraud. Do you have valuable information that can lead to exposing managed care insurance fraud? Meet with our experts today, for a free and confidential review of your allegations.