Learn to recognize fraud and protect yourself as a whistleblower

On Behalf of | Jan 26, 2019 | Blog |

Wherever there is a chance, there is likely a person who is trying to take advantage of the government or other systems for their own benefit. The reality is that fraud is extremely common, and it’s something that the government relies on others reporting.

There’s no way for the government to know, or be able to discover, all the fraud that takes place. That’s why it provides whistleblower protections to those who discover and report fraud.

Why are whistleblower protections important?

Whistleblower protections are important because they guarantee that you won’t lose your job or, if you do, financial support as a result of making a report in good faith when there is fraud in your workplace.

Here’s an example. If you work in an insurance and accounting department at a hospital and notice a doctor billing for refills that a patient doesn’t need or hasn’t filled, this could be Medicare, Medicaid or insurance fraud. It’s important to inform the authorities about this, since it’s taking advantage of a system that is finite in nature.

What are a few kinds of Medicare fraud?

Some common types of Medicare fraud include:

  • Fraudulent patient billing, which is when patients work with providers to obtain kickbacks in exchange for Medicare coverage of treatments never performed
  • Phantom billing, which is where the provider bills for procedures that never took place or that were unnecessary
  • Upcoding, which is when billing amounts are inflated through the billing code
  • Unbundling, which is where services are charged at a higher rate by separating them instead of bundling them together

Fraud usually happens without people noticing it, but patients and those working in accounting offices may be able to recognize it taking place. Compare patient bills to the claims to Medicare. If there are discrepancies time and time again, then there could be fraud taking place.

What should you do if you believe a provider is acting fraudulently?

You are able to report fraud by filing a report through the Office of the Inspector General and the U.S. Department of Health & Human Services. Your attorney can also help you look into the situation further before you file a complaint that may not be accurate. If you and your attorney agree that it needs to be reported, then your attorney can help protect you and your position as you move forward with a whistleblower case. Retaliation can be common, so it’s a good idea to protect yourself.