The United States pays out more than $ 1 Trillion each year through the Medicare and Medicaid programs for the care of beneficiaries including the elderly and disabled. This expenditure is an enticing target for fraud, and the government estimates hundreds of billions of dollars are lost to fraud each year. The statistics on recovery, roughly $2-3 Billion each year, show that even under the best of circumstances fraud against the Medicare and Medicaid programs is rampant.
With the start of the COVID-19 pandemic, however, the potential for frauds on these programs has increased. The risk of fraud is due, in part, to modifications to the government’s health care programs to account for public health guidance restrictions and efforts to free up resources to treat a surge of patients with COVID-19. According to a study conducted by the Commonwealth Club and the SCAN Foundation, 212 different policies relating to the Medicare and Medicare programs have been modified because of the pandemic. While some of these policy changes have ushered in long-overdue improvements to the programs, they have also introduced new ways to commit fraud on the system.
One major policy change as a result of the pandemic was to permit and reimburse for more use of Telehealth. But the hundreds of other changes also included waivers to certain restrictions to the Stark Law and who can be a Medicare provider. For hospitals faced with a flood of COVID patients, CMS’ temporary rules also relieve hospitals of the requirement that they treat patients within their own facility. While this successfully opened up hospital beds for COVID patients, transferring patients to ambulatory surgery centers, rehabilitation hospitals – and even hotels and dormitories – while still getting reimbursed by Medicare, present new ways to defraud the government.
How to Help
The federal government will continue to pay out hundreds of billions of dollars for the care of tens of millions of beneficiaries unrelated to COVID-19 well into 2021. As long as we live under the shadow of the pandemic, the rules for how those programs will have to operate will increase the risk of fraud against the government. If you are a health care worker and have information about one of these frauds, please call us or fill out the form below for a free and confidential consultation.
Who we are
Keller Grover LLP
Whistleblower cases require lawyers litigating them to prove a fraud while protecting their client who typically learns of the fraud at work. While many law firms have experience dealing with fraud cases or employment issues, few are experienced enough to handle both issues together. The lawyers at Keller Grover have over 30 years of experience litigating both fraud and employment matters, and more than a decade of experience litigating cases involving violations of the federal False Claims Act and the state equivalents. We have secured groundbreaking decisions interpreting these laws on numerous issues relevant to all whistleblowers. We are also regularly featured speakers on all aspects of our law practice to audiences including other qui tam lawyers and government lawyers. We have secured judgments totaling tens of millions in recovery to taxpayers. This rare combination makes Keller Grover uniquely qualified to represent whistleblowers.
Contact Us
If you have information about a fraud involving Medicare, please call us or fill out the form below for a free and confidential consultation.