Atlanta Hospital Fraud Attorney
Atlanta’s hospitals have earned strong national reputations for providing critical care to the city and surrounding areas. Bringing together surgeons, doctors, nurses, radiologists, and lab clinicians, these hospitals provide care to thousands of patients every day for almost every medical condition imaginable.
According to the government, however, hospitals are also a major source of healthcare fraud. Indeed, roughly one third of all civil investigations into health care fraud target hospitals, and the size of the problem is enormous. Collectively, health care fraud costs the government over $30 billion a year.
Atlanta’s hospitals are not immune from fraud. Competitive pressures, as well as old fashioned greed, compel many hospital administrators and staff to hatch fraudulent schemes that cost taxpayers millions of dollars. At Stacey Evans Law, we fight government waste and encourage anyone with information about hospital fraud to contact us.
Hospital Fraud is Pervasive
Unfortunately, there are many ways hospitals might commit fraud by submitting false claims to government insurers like Medicare for reimbursement. Some examples include:
- Coding procedures inappropriately, such as “upcoding”
- Illegally unbundling services
- Billing for unnecessary medical procedures
- Billing for procedures which are not performed
- Waiving Medicare co-pays to induce patients to use the hospital’s services
- Retaining overpayments past 60 days
- Classifying patients as sicker than they are to receive outlier payments
- Offering kickbacks to health care providers for referrals
- Receiving kickbacks to refer patients to nursing homes, hospice services, or home health care providers
Many patients are completely unaware that fraud has been committed. Instead, they are simply grateful to feel well and don’t closely examine a bill, believing that an insurer will scrutinize it.
Conversely, some hospital employees are aware of bits and pieces of a fraudulent scheme even if not entirely sure something illegal is happening. Often, fraud involves multiple people like doctors, medical staff, or clerical staff like secretaries or billing departments. Though they suspect something is afoot, they keep silent out of fear.
It is Illegal to Defraud a Government Program
The False Claims Act is a federal law that makes it illegal to submit a false claim to the government for reimbursement. If caught, violators can be forced to pay back three times the amount of money they bilked from the government. They also can pay fines and be excluded from participating in Medicare or Medicaid.
However, many hospital administrators know they provide critical services to their communities, and they reasonably believe that the government won’t exclude them from accepting Medicare patients in the future. For this reason, hospital administrators sometimes turn a blind eye to reported fraud.
If you suspect hospital fraud, please contact Stacey Evans Law today. We can meet to discuss whether you want to blow the whistle on this activity and seek compensation in a qui tam lawsuit under the False Claims Act.
