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DOJ says mom and pop health care company committed Medicare fraud

Companies of all sizes may engage in business connected to government contracts. It is not only large, multi-national corporations that seek reimbursements for providing health care services or goods. The Department of Justice announced earlier this month that it is joining a lawsuit filed against a husband and wife team who allegedly ran a dramatic scheme to overbill Medicare for services through a process commonly referred to as “upcoding,” according to the Chicago Tribune.

Upcoding involves using the codes for more complex or more difficult services than were actually performed to receive more taxpayer money than is medically necessary or reasonable. The DOJ says that the upcoding was so exaggerated, at times, that it would take a doctor 24 hours or more in a single day to administer the care the company claims to have provided. Investigators performed time and distance analysis during the government investigation.

Two civil lawsuits are on the docket

In addition to joining the pending lawsuit, the government filed a case against a second business run by the same couple. Officials believe that the husband and wife team unlawfully sought reimbursements from Medicare for services that were never provided. The man and woman may also face criminal charges related to the allegations.

The recent announcement does not identify an exact amount of how much money the government believes the alleged fraudulent schemes involved. However, the DOJ says the full amount may be in the millions.

Workers in small companies who suspect that their employer is committing fraud in a government contract may feel that the scheme cannot amount to much. However, as the recent lawsuits against the couple in today’s story show, the harm and cost to taxpayers can be significant. Workers who come across evidence of health care fraud may speak with a lawyer who has a strong understanding of whistleblower lawsuits for guidance on how to proceed.

Health care fraud claims continue to lead the way for whistleblower lawsuits. Private citizens who uncover evidence of Medicare fraud may file a lawsuit on behalf of the government. Whistleblowers help the government to recover taxpayer money that is unlawfully obtained through fraudulent practices. Moreover, the whistleblower is entitled to receive a portion of any settlement or verdict that results from the lawsuit.

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