Atlanta Cost Report Manipulation Attorney
Health care fraud takes many forms, and sometimes a manipulated cost report is used as part of a fraudulent scheme. Generally speaking, hospitals initially bill Medicare using a UB-92 form (or an electronic equivalent). At the end of the year, the hospital submits a cost report which helps Medicare reconcile the payments throughout the year with any amounts that were reimbursed or which need to be returned by the hospital.
Unsurprisingly, hospitals and other providers can manipulate a cost report to commit fraud or hide fraud committed earlier in the year. Government health programs are so large that the opportunity to commit fraud is immense. Many hospitals and for-profit entities feel competitive pressures to increase their bottom line, and some of them succumb to fraud.
If you have evidence of cost report manipulation, contact Stacey Evans Law. It is illegal to defraud the government, and you could have important rights as a whistleblower.
Examples of Cost Report Fraud
Some of the most common fraudulent entries on a cost report relate to:
- Including improper costs. Medicare pays proportionally for some costs, such as capital costs. However, a hospital could include costs which are not allowable.
- Shifting costs between centers. Medicare will not pay for expenses at certain cost centers. However, a hospital could shift costs between centers so that they receive payments they aren’t entitled to.
- Seeking reimbursement for costs related to non-Medicare patients. This is an obvious form of fraud. Sometimes hospitals will try to apportion costs between patients and include a patient who isn’t even on Medicare.
- Manipulating statistics related to the hospital, such as its square footage or patient census.
- Falsely requesting outlier payments. Although Medicare typically pays a fixed amount for a patient, hospitals can request supplemental payments (“outlier payments”) for atypical expenses when a patient is very sick. Hospitals might falsely request this type of payment when the patient’s profile does not support it.
Hospitals must certify that a cost report is accurate when they submit it. Including false information can render the cost report a violation of the False Claims Act.
Fighting Fraud
Medicare fraud is often difficult to detect, and savvy hospitals can use manipulated cost reports to cover up their tracks. Often, fraud is only uncovered because someone on the inside has evidence of it and they blow the whistle to government regulators or otherwise try to fight it internally.
Our Atlanta cost report manipulation attorneys can explain your rights under the False Claims Act to bring a qui tam suit. This type of lawsuit seeks to disgorge a hospital’s fraudulently obtained proceeds. Violations are punishable by paying back triple the amount defrauded, plus additional fines. A whistleblower who brings a successful qui tam lawsuit can receive a portion of the proceeds.
Contact Stacey Evans Law Today
We offer free, confidential consultations to those with evidence of cost report manipulation or other healthcare fraud. Call today to schedule a time to speak.
