There are many different forms of fraud that involve billing Medicaid. In some cases, a doctor, billing specialist or medical business will intentionally bill for drugs, procedures or services that were never administered or performed. In other cases, doctors or dentists perform unnecessary medical or dental procedures on unwitting patients. One of the less known forms of Medicaid fraud is time theft, where a doctor, therapist or other professional bills for time when no services were provided to the client.
The person or parties responsible are often prosecuted if the government discovers the fraud. Those who knew about the fraud but did nothing could also face charges. While calling attention to illegal practices by your employer may result in retaliation, mistreatment and firing of whistleblowers is also illegal. If you believe that your employer or someone you work with is committing time theft or another form of Medicaid billing fraud, you will want to work with an attorney who understands the False Claims Act.
Small discrepancies add up over time
In cases where a medical professional, technician or therapist is supposed to provide regular services to a client, small time discrepancies can add up to major fraud. Consistently arriving five to ten minutes late to weekday in-home therapy sessions, for example, adds up to nearly an hour of billable time each week. Over the course of the year, that adds up quickly. Even ten minutes a day, five days a week ends up being 2,600 minutes billed fraudulently. That's more than a full week's worth of work, illegally billed to the government for services that were not provided.
If you extrapolate that time theft and fraud across multiple clients or patients a day, it's easy to see why time theft of this sort is a serious concern. Performed on a large scale, even by one employee, this kind of fraud will cost the government and taxpayers large amounts of money.
It isn't easy to come forward, knowing that someone else could get in trouble as a result. However, failing to do so makes you complicit in the crime. Even if you are never legally charged with anything, you will have to live with the knowledge that you knew about ongoing fraud and did nothing to stop it.
An attorney can protect you when you come forward
Shining a light on ongoing fraud can be nerve-wracking. Working with an attorney who understands the False Claims Act can help. Under the law, if you don't know where to report the fraud, you can bring a civil suit against the party committing the fraud. In these cases, if you bring a suit against someone engaged in fraudulent billing, you may be awarded anywhere from 15 to 25 percent of the funds recovered. Sometimes, doing the right thing actually pays. Don't let your knowledge of potential fraud bother your conscience. Contact an experienced fraud and Qui Tam lawyer.
Source: Nov. 30, -0001