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Florida Hospital Fraud Lawyer

Many of the claims filed by whistleblowers under the False Claims Act occur within the healthcare field, which includes fraud committed by hospitals and medical facilities. Hospitals in particular have recently come under fire for engaging in fraudulent practices like upcoding and taking kickbacks. Whistleblowers who have insider knowledge of these types of practices are often rewarded for bringing fraud to the attention of the federal government, so if you believe that a hospital is committing fraud, you should speak with a Florida hospital fraud lawyer who can evaluate your case and advise you accordingly.

Inpatient Fraud

Hospital fraud can be broken down into three main categories, the first of which is hospital inpatient fraud, or fraud that occurs during inpatient processing.  Because of the way Medicare laws are structured, inpatient services are generally billed differently than outpatient services, with federal programs paying larger reimbursements for inpatient services, as the costs of holding a patient overnight are higher. Common examples of hospital inpatient fraud include:

  • Upcoding, or billing patients for a service that is more expensive than what was actually performed;
  • Unbundling, which involves billing patients for services separately that should have been billed together;
  • Billing Medicare separately for related discharges and readmissions on the same day;
  • Billing federal programs for inpatient stays resulting from diseases acquired during a different hospital stay; and
  • Failing to adjust inpatient claims after receiving medical device credit for the replacement of medical equipment.

To learn more about the types of inpatient billing practices that could qualify as fraudulent, please reach out to our office today.

Outpatient Fraud

Outpatient fraud is a term used to describe the use of deceptive practices when billing Medicare and Medicaid for outpatient treatments and discharge. Outpatient services are almost always cheaper than inpatient services, which can motivate some hospitals to keep patients overnight, even when that level of medical attention isn’t necessary. To prevent this, the federal government sets standards on what types of conditions justify inpatient processing. Unfortunately, many hospitals ignore these standards, opting to charge Medicare and Medicaid for overnight stays that were not necessary because they are more expensive. Ignoring these standards, however, is a violation of the False Claims Act and can result in significant fines for wrongdoers and rewards for whistleblowers.

Cost Report Fraud

The third most common type of hospital fraud is cost report fraud, which occurs when hospitals:

  • Inflate the costs of providing care to patients;
  • Seek reimbursement from government programs for costs incurred by patients who are not covered by Medicare or Medicaid;
  • Seek reimbursement for the care costs of non-patients; and
  • Fail to disclose their relationship to other companies with whom they are in business.

Unfortunately, this type of fraud is relatively easy to commit due to a lack of government oversight, making it especially important for insiders with firsthand knowledge of the fraud to initiate qui tam lawsuits on behalf of the government.

Call Today for Help with Your Claim

Please contact McCabe Rabin, P.A. by calling our office at 561-659-7878 to learn more about filing a whistleblower claim against a hospital that is engaged in deceptive practices.

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