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Is your company committing Medicaid fraud?

On Behalf of | May 27, 2020 | Medicare / Medicaid Fraud

As a person and a professional, you likely feel certain obligations when you suspect or confirm wrongdoing. If you are in the healthcare industry, you may find yourself in a position to either speak or stay silent when an individual or company is taking advantage of one or more of the government programs available to help Americans.

The state of healthcare fraud in America

While you decide whether to report, ponder this: The fraud problem in the U.S. healthcare system costs $100 billion annually. If that money wasn’t allocated for this problem, it could potentially fund more healthcare programs or enhance the currently available programs instead of driving up your insurance premiums and your clinic visit costs.

There are numerous types of medical billing fraud, including billing errors and mistakes, misclassification of a diagnosis or procedure, or deliberate upcoding. The first two can happen accidentally or due to a lack of training. Upcoding is the primary concern here.

What is upcoding?

When physicians “game the system,” for their own profit, it is upcoding. Essentially, it means dishonestly manipulating the billing system.

Examples of upcoding include:

  • Billing a one-hour visit for what was actually a 10-minute check up
  • Billing for treatments not provided
  • Billing for “phantom patients”
  • Double-billing for goods or services
  • Reporting symptoms that are not present to secure an (arguably) unnecessary test

If you suspect wrongdoing at the facility you work at, you might consider reporting to the compliance department. If your company does not respond, submitting a hotline complaint to the U.S. Department of Health and Human Services could be your next step. An experienced lawyer can advise you on taking the process further.