There are three main funding sources for health care in the United States: the government, private health insurers and individuals. However, in 2018, 34 percent of Americans received their health care via government insurance or direct public provision…we are primarily talking about Medicare and Medicaid. Both Medicare and Medicaid are funded by your tax dollars.
Doctors who provide services to Medicare and Medicaid patients bill the government for their services…and they often defraud the government (read you) with those bills. The most frequent ways doctors commit fraud by submitting claims for payment include:
● Billing codes that reflect a more severe illness than actually existed or a more expensive treatment than was provided
● Billing medically unnecessary services
● Billing services not provided
● Billing services performed by an improperly supervised or unqualified employee
● Billing services performed by an employee excluded from participation in the Federal health care programs
● Billing services of such low quality they are virtually worthless
● Billing separately for services already included in a global fee, like billing an evaluation and management service the day after surgery
These actions are wrong and there is a remedy provided by the False Claims Act. If you work in medical coding/billing or are otherwise aware of fraudulent bills being sent to Medicare and Medicaid call us….we can help.