Florida Upcoding Fraud Lawyer
Healthcare fraud can take a number of different forms, but most often involves improper billing practices. Upcoding, which is a type of fraud in which healthcare providers submit inaccurate billing codes to insurance companies in an effort to receive inflated reimbursements, has proven to be an especially serious problem in the healthcare industry. Fortunately, it is possible to report this type of fraud and to hold the wrongdoers accountable, so if you work in the healthcare industry and have discovered the use of deceptive billing practices by a hospital or physician, you should consider speaking with an experienced Florida upcoding fraud lawyer who can walk you through the claim filing process.
How Does Upcoding Work?
Healthcare providers use a specific set of codes, known as Current Procedural Terminology (CPT) codes, that represent all of the conditions, procedures, and drugs that are reimbursable by insurers. Each of these codes also has an associated cost for insurance companies and individuals that is based on the urgency of the issue and the complexity of the treatment or procedure in question. For instance, a five minute consultation with a nurse for a minor issue would be billed under a code with a relatively inexpensive charge, while a bill for a full hour-long examination by a physician would be charged differently. In this example, upcoding would occur if a provider charged Medicaid, Medicare, or another federal program for the more expensive and complex examination regardless of the type of consultation that actually took place. These types of practices violate federal law, which prohibits healthcare providers from defrauding government programs.
Identifying and Reporting Upcoding
Deceptive billing practices like upcoding can be difficult to detect, especially in large institutions like hospitals that have a greater range of procedural options and where the process of billing Medicare tends to be lax. While investigative agencies attempt to discover upcoding fraud, one of the most successful ways to hold healthcare providers accountable for fraud remains in the hands of whistleblowers, who with their insider knowledge, can bring proof of widespread fraudulent practices to the attention of the proper agencies. In many cases, physicians, administrators, executives, and accountants at medical institutions are often in the best position to recognize and report upcoding and similar billing irregularities.
Filing a Whistleblower Claim
Those with proof of a healthcare provider’s use of deceptive billing practices often have the option of filing a lawsuit on behalf of the federal government. These are known as qui tam lawsuits and are permissible under the False Claims Act, which entitles plaintiffs to a reward of between 15 and 30 percent of any amount recovered in damages by the government. Fortunately, whistleblowers who report this type of activity are specifically protected from being fired or demoted by their employers in retaliation.
Do You Have an Upcoding Fraud Claim?
If you have proof that a healthcare provider is engaging in deceptive or fraudulent practices when billing insurers, please call the experienced Florida upcoding fraud lawyers at McCabe Rabin, P.A. to learn more about filing a whistleblower claim against that institution. We can be reached at our office at 561-659-7878 or via online message, so don’t hesitate to reach out to our legal team today.