Healthcare fraud cases are on the rise, and attorney generals across the country are holding them up as proof they're doing good work. Because taxpayers foot the bill for entitlement programs like Medicaid and Medicare, catching those who bilk the system is a political feather in any AG's cap.
Michigan has assigned a team, the Health Care Fraud Division, to focus on this niche area of law. The agency measures its success rate by the more than $21 million it has secured through litigation. However, healthcare fraud fever can also lead to overzealousness.
Those in healthcare business may find themselves in legal hot water because of treatment methods or common bookkeeping errors. Here are just a few of the issues facing the healthcare industry.
Bundling and bookkeeping
It is a standard practice to charge health insurance providers for procedures that are done together through a single invoice in order to streamlines costs. However, when communication breaks down between healthcare professionals and bookkeeping, services may be mistakenly broken out into separate charges. If your system has a glitch and this problem takes root in everyday practices, it could lead to a fraud investigation.
Treatment and judgment
Under the False Claims Act, healthcare businesses can be the subject of fraud charges based on the level of services they provide. Aggressive prosecutors may seek to exploit this often murky area. Examples include:
- Inadequate services: In the interest of efficiency, nursing homes sometimes bill for services on a per diem basis, taking into account average use and costs. The usage may ebb and flow throughout the year. But, when these services are underused for a period of time, it can be misconceived as a failure to provide services.
- Aggressive treatment: On the opposite end of the spectrum, some doctors press hard for additional tests in order to gain a complete picture of a patient's condition. Doctors are motivated to help and heal: They are not bean counters. Although they may be working hard to ensure good health for that person, it can be viewed as a way to charge insurance carriers for unnecessary services.
Enticements for whistleblowers
Healthcare fraud has become a hot topic, which often needlessly questions the judgment of dedicated healthcare providers and second-guesses complex bookkeeping methods. An example of government aggressiveness demonstrated by the $1,000 reward the State of Michigan offers to reporters of alleged frauds.
Reminiscent of an Old West bounty, people are offered cash to point fingers at doctors, HMOs, hospitals and other medical care professionals and facilities. Don't face these serious allegations of fraud without competent professional assistance. Seek the help of the experienced fraud defense lawyers at the law firm of Dawid & Gatti.