No one wants to work for a company that is knowingly committing fraud or other workplace violations. When an employee does notice their employer committing fraud, they may not say anything for fear of retaliation. There are whistleblower laws in place to protect you after workplace retaliation.
Fraud is a serious crime that can come with considerable consequences for those who commit it. If you hold a career where Medicare or Medicaid fraud is possible, it is important to know what kinds of fraud may be happening in your workplace. Three common forms of fraud include:
In some cases, medical services are cheaper for a client and their insurance if they are billed as a package. Sometimes, a health care provider may decide to boost income by separating these bundled items before billing, so the total cost of the items is higher.
A patient in a hospital may be looking for answers or information about their illness or injury, and a health care provider may exploit that. By sending the patient through multiple tests and doctors, they may try to inflate the total cost of the patient’s care.
In addition to sending a patient to unnecessary services and manipulating the bill, a health care provider may be so bold as to add services that never happened to a bill. This “phantom billing” or “upcoding” is one of the many forms of fraud that can have many consequences.
Do not turn a blind eye to fraud
If you suspect your employer of Medicare/Medicaid fraud, know that the law will protect you from retaliation for reporting it. If you want to learn more about how the law can protect you or how to report workplace fraud, consult with an employee rights attorney for the guidance you need.