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All information provided about the law is very general in nature and should not be relied upon as legal advice. Every situation is different and should be analyzed by a lawyer who can provide individualized advice based on the facts involved in your unique situation, and a consideration of all of the nuances of the statutes and case law that apply at the time.

What is healthcare financial fraud?

This type of healthcare fraud involves falsifying billing codes that users have to include when they send in claims to the government.

Fraud within the healthcare industry costs Americans more than $100 billion a year and causes harm to vulnerable segments of society such as seniors and those struggling with low income according to a recent CNNMoney report. Complaints filed and prosecuted by whistleblowers are the single most effective way to fight this type of fraud against the government, which make healthcare costly for so many people.

Under the False Claims Act, a whistleblower in a healthcare fraud case can receive up to thirty percent of what the government recovers as a reward for the recapture of public funds. Our False Claim Act Lawyers can assist clients in filing whistleblower cases then coordinating or negotiating with the federal government.

Whistleblowers must have access to documents, witnesses or other evidence of fraudulent acts that reveal that the alleged wrongdoer is obtaining public funds based on false information, misrepresentations, overbilling, fraud and similar acts of financial impropriety. Naturally, many whistleblowers are nurses, doctors, pharmacists and those who work directly with patients. But those who work in hospital administration or other administrative positions can also act as a whistleblower, as can accountants, benefits officers and others who work in finance.

Some people try to defraud the government simply by turning in a false claim for a non-existent illness or medical treatment. However, other schemes can be much more complicated and involve hundreds of pages of reports with fabricated hospital costs or medical claims. Claims research shows that medical billing fraud is the most common scheme reported in healthcare-related cases. This type of healthcare fraud involves falsifying billing codes that users have to include when they send in claims to the government. Some schemers will try to double bill for the same services or charge for medical devices or services that are not medically justified and/or provided to patients. Others try to “upgrade” an illness by exaggerating its severity and charging more for treatments and medications. Healthcare fraud can even involve kickback schemes where pharmaceutical companies try to pay doctors or nurses to refer patients to a specific drug or product. This is prohibited by the federal government by the Anti-Kickback Statute.

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