The high cost of health care has been a hot topic in the media, at the water cooler and in homes throughout the Milwaukee area for some time now. Some people who work in the health care industry may feel the need to defend the industry during these public debates. At the same time, however, health care fraud has cost taxpayers an exorbitant amount of money. The Department of Justice (DOJ) says that since January 2009 the agency has recovered nearly $20 billion, thanks in large part to whistleblowers who have come forward with evidence of fraud against federal health care programs.
It is important to note that Medicare fraud can occur all along the stream of services in the health care industry. In early 2011, an employee in the company's billing office began noticing oddities in billing practices the he believed including inflated costs to Medicare, as well as seeking reimbursements for unnecessary transports. She brought her concerns to the attention of upper management, but billing discrepancies continued, according to a recent False Claims Act lawsuit.
The DOJ says that from the beginning of January through October 2014, the medical transport service improperly billed Medicare for unnecessary services or miscoded services, inflating the charges to increase its own revenues. Examples that were alleged in the lawsuit include:
- Transporting a patient who was able to walk and not confined to a bed via stretcher and ambulance to a routine appointment
- Billing Medicare directly and for full-service for transporting patients under a contract with a municipality despite agreeing in the contract to a small fee, with the municipality remaining responsible for billing Medicare
Working with a private attorney, the employee brought the evidence to the attention of the DOJ and filed a lawsuit. Earlier this month the ambulance company settled the fraud allegations of lawsuit for $12.7 million. The whistle blower will receive roughly $3.5 million of that settlement. U.S. Attorney Carmen Ortiz says that, "this settlement is part of the office's ongoing effort to eradicate health care fraud, and return money to the taxpayers." The company denies wrongdoing in the settlement.
The former employee is still pursuing a wrongful termination lawsuit that alleges the medical transport company unlawfully terminated her in retaliation for raising complaints about the fraudulent practices of the organization.
Since the spring of 2009 the agency has focused heavily on Medicare and Medicaid fraud to combat the ever increasing costs of healthcare. The False Claims Act provides whistle blowers with strong legal protection to bring forward evidence of fraud. If you have uncovered evidence of fraudulent activity, you should speak confidentially with an experienced lawyer with a strong command of False Claims Act claims who can guide you through your legal options.