Nurses can be foremost witnesses to fraud within the healthcare system. Healthcare workers are caught between their duties to deliver quality patient care and an administrative system attempting to remain profitable. Nurses and other healthcare workers have been witnesses and even been asked to participate in fraudulent billing acts, such as:
- documenting care never performed;
- upbilling for services never rendered;
- upcoding for procedures never performed;
- off label drug marketing by pharmaceutical sales reps;
- ordering unnecessary lab tests to increase payments;
- documenting home health care visits that never happened;
False Claims Act
The False Claims Act authorizes the government to recover the funds that have been misappropriated by fraudulent billing. The Act covers governmental funds that have been illegally obtained by fraud. This includes Medicare and Medicaid bills that have been paid, but does not include private insurance.
If a recovery is obtained, the person that reported (the whistleblower) is eligible for a award of up to 30% of the amount of the government’s recovery. The percentage of the award is based upon the evidence and participation of the whistleblower.
Document the Fraud
Evidence of repeated over charging, upcoding, patterns of performing unnecessary procedures, kickbacks from drug reps, off label marketing of products, and other acts of fraud must be documented and recorded.
There are anti-retaliation statutes that protect whistleblowers that expose complaints. Many state and federal laws, including the Sarbanes-Oxley Act, protect whistleblowers from retaliation by their companies and employers.
If you have exposed and documented fraudulent over billing practices, contact us at 1-800-814-4540 or firstname.lastname@example.org for a free initial consultation.