What To Do When Medical Billing Fraud Occurs

Medicare and Medicaid reimburse physicians and health care entities based on a complicated coding system that defines exactly what services have been provided to patients. All too often, though, medical providers attempt to game this billing system to increase their profits. If you have observed an individual or entity that has done this, you can bring a qui tam/whistleblower claim to stop this illegal conduct. In addition to helping prevent future wrongdoing, when you file a claim you are also eligible to receive a percentage of any money that the government recovers as a result of the qui tam case.

A Trusted Attorney To Guide You Through Your Medicare/Medicaid Whistleblower Case

At John A. Klassen, PA, we have helped numerous clients in Minneapolis and throughout Minnesota stand up for what is right and hold those who misuse medical billing for their own personal gain. Led by attorney John Klassen, a dedicated trial lawyer with two decades of experience, we have the insight and track record of success necessary to help you navigate through even the most complex type of whistleblower claims.

Types Of Medical Billing Fraud

Fraud related to medical billing typically takes on four different forms:

  • Upcoding: When physicians of health care entities claim that more time was spent with a client than what actually was, or when they “upgrade” a procedure improperly, it is referred to as upcoding. By using a different code than the one that more accurately reflects the services rendered, they fraudulently increase the amount of compensation they receive.
  • Unbundling/fragmentation: Many services can be “bundled” together to receive a discounted rate. For example, multiple laboratory tests may be included in the same code because they are commonly run at the same time. Discrepancies in the system, however, make it more lucrative to bill these bundled services separately — which improperly increases their cost and rate of reimbursement.
  • Phantom billing: In this scenario, the improper conduct involves billing for services that were never rendered.
  • Double billing: Just as it sounds — charging twice for a service that was rendered only once.

Case Result: John served as co-lead counsel in a False Claims Act fraud complaint for a physician’s upcoding and fraudulent billing under Medicare and Medicaid. We recovered $252,000 for the United States.

An Employment Attorney Serving You

Call 612-217-4988, or complete our online form to arrange a consultation and receive the answers you need. We will provide you with straightforward advice and all the information you need to make a well-reasoned decision about your case.