Health care fraud costs taxpayers an exorbitant amount of money. The federal government, however, does not always detect fraudulent practices in processing Medicare, Medicaid, Tricare and similar reimbursement invoices from health care providers nationwide. Many instances of fraud related to government contracts and health care programs are discovered by workers in the relevant industries. Health care workers at any level may detect irregularities in billing practices that unfairly cost taxpayers more money than the services are worth.
The Department of Justice says that a dermatology practice in the South violated the False Claims Act by overcharging Medicare and Medicaid for services provided to residents of assisted living facilities, retirement communities and similar entities. The dermatology practice allegedly abused the rules related to non-melanoma skin cancer services using superficial radiation therapy. The end-result, according to a recent lawsuit, was increased revenues to the health care providers without a medical basis.
Upcoding, Failing To Properly Supervise And Over Utilization Of Services
The government believes that during the calendar years from January 2011 through December 2016, the dermatology company used a technique known as upcoding to increase government reimbursements. Upcoding is the practice of using a medical billing code that is more expensive than the medical procedures performed, or medical services provided. In addition, the DOJ says that the health care provider failed to properly supervise the administration of superficial radiation therapy, as well as over-utilized radiation simulations. The dermatology practice recently settled the lawsuit for $4 million, without admitting liability or wrongdoing.
While workers and professionals at any level of the industry may uncover evidence, the recent case was initiated by a dermatologist. Whistleblowers who originally file a lawsuit alleging health care fraud are entitled to receive a portion of any verdict or settlement that results from the lawsuit. A recent press release does not indicate how much money the dermatologist will receive for bringing the case forward.