Under both the Medicare and Medicaid programs, the government healthcare programs set specific billing codes which represent certain services to be used by healthcare providers to submit claims for payment to the government. In many cases, government healthcare programs have special reimbursement rates for groups of procedures that are typically performed together, such as laboratory tests. Manipulating or altering billing codes to maximize reimbursement from government healthcare programs like Medicare and Medicaid is a type of healthcare fraud. One common type of fraud has been to “unbundle” these procedures or tests and bill each one separately, which results in greater reimbursement than the group reimbursement rate. Some healthcare providers defraud the government by “unbundling” these codes and billing the services individually. This again causes the government to pay more than required based on a fraudulent billing practice and can violate the False Claims Act.
If you believe someone has knowingly committed Medicare or Medicaid fraud and you would like to learn more about or bring a Medicare or Medicaid whistleblower lawsuit, the qui tam lawyers at Keller Grover LLP can help you. These whistleblower lawyers understand qui tam litigation, including the whistleblower protection provisions, and strive to achieve the best possible results for their clients.