How Does Health Care Fraud Typically Get Uncovered?

How Does Health Care Fraud Typically Get Uncovered?


04/11/2013 // Whistleblower Law Firm // Keller Grover // (press release)

Health care fraud is one of the biggest drains on the health care system in the United States today. It impacts those who are most vulnerable in society, like the poor or elderly, by making access to quality health care more difficult. At a time when the federal government is trying to rein in healthcare spending, prevention of fraud, waste and abuse are high priorities.

Unfortunately, among the medical care providers such as doctors, dentists, clinics, hospitals, nursing homes, and others who contract with the government to get reimbursement for services there are some who engage in fraud on health care programs like Medicare or Medicaid to obtain public funds for their personal gain.

Some of the most common examples of health care fraud involve actions such as:

• False billing for care that has not been provided

• Overcharging for services or drugs

• Billing for brand name prescriptions and medical products when generic versions are actually provided

• Performing and billing for unnecessary procedures

• Billing for appointments that were made but subsequently cancelled without being rescheduled

Many consumers assume the fraudulent practices of medical care providers are uncovered or caught by government audits automatically. However, the GAO estimated that Medicare and Medicaid made more than $65 billion in fraudulent and incorrect payments in 2011, according to With the help of accountants or others who take care of medical billing, medical personnel, secretaries, and other employees with insider knowledge about fraud a significant number of wrongful actions are actually reported by workers who see unethical or illegal practices on the job.In fact, in 2012 the federal government recovered more than $4 billion in fraudulent payments attributable in large part to the help of whistleblowers.

The health and safety of the public can be protected by whistleblowers that help uncover the actions of those involved in fraudulent medical billing or cheat the government out of needed funds. A whistleblower lawyer can provide counsel and support to employees who feel the moral imperative to report this type of behavior to the proper authorities.

If you have information about false billing or other acts of wrongdoing by a medical care provider, it may be helpful to speak with the whistleblower attorneys of Keller Grover about your options and to help you navigate the legal system. We offer a free, confidential consultation to discuss your case personally.

Source: federal whistleblower lawyers

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