What To Look For

Are you aware of your employer willfully engaging in practices that defrauded Medicare, Medicaid or any other government program?  Some fraudulent practices to look out for include:

  • “Upcoding”, or billing for more expensive services than were actually performed.
  • Billing for services already included in a global fee.
  • Billing for services performed by an improperly supervised or unqualified employee.
  • Billing for services never performed.
  • Performing medically unnecessary treatments.
  • Making inappropriate payments to doctors to gain patient referrals.
  • Making inappropriate deals with pharmaceutical companies for drug dispensation.

Example Case Study: Kindred Healthcare

In 2016, Kindred Healthcare, the nation’s largest nursing home therapy provider, paid $125 million to resolve False Claims Act allegations (with no determination of liability).  According to the U.S. Department of Justice the allegations included submitting false claims to Medicare for rehabilitation services that were “not reasonable, necessary and skilled, or that never occurred”.

Other allegations from this case included:

  • Placing patients in the highest therapy level rather than relying on individualized evaluations to determine suitable level of care.
  • Scheduling and reporting the provision of therapy even after the patients’ therapists had recommended that they be discharged.
  • Reporting that skilled therapy had been provided to patients when in fact the patients were asleep or otherwise unable to undergo or benefit from skilled therapy.