Illegal kickbacks

Some pharmaceutical companies will offer incentives to hospitals or doctors for prescribing or using their products over those of others, including when it is not necessary. These acts are illegal. The incentives may be financial in nature or more subtle, such as all-expenses-paid trips.

Billing fraud: Phantom patients, unbundling and upcoding

Health care organizations and doctors bill the Medicaid and Medicare systems by entering codes for different medications and treatments. Often, the bills that are sent are inflated through the use of fraudulent billing practices. Some facilities also may bill for non-existent or phantom patients. Some providers also bill for services that were not performed or that were not needed. Unbundling and upcoding also frequently occur. Unbundling involves separating services out that are normally bundled together in order to increase the total price. Upcoding involves billing for a more expensive type of treatment than what was actually performed.

False certifications

When claims for Medicaid or Medicare services are submitted, documentation of the claims’ veracity must also be sent. In some cases, the signatures of doctors are forged on the required forms. Substituting lower-quality equipment in the place of more expensive equipment may also involve false certifications.

Have you witnessed health care fraud?

If you are in the health care industry, and you have witnessed any of these types of health care fraud and abuse, you may be able to file a qui tam lawsuit under the False Claims Act. Swartz Swidler will help to guide you through every phase of the process. Our experienced lawyers have proven records of litigating complex health care fraud cases for our clients. To schedule your consultation, contact us today.