Billing for Medically Unnecessary Services

Stop Fraud with Our Atlanta Medicaid/Medicare Fraud Lawyer

Medicare, Medicaid and TRICARE are being tricked into paying for medical services that patients don’t need. If you know of patients who received medically unnecessary services or durable medical equipment, you can stop the fraud and help protect the patients by filing a False Claims Act lawsuit. Whistleblowers who help the Government stop healthcare fraud are entitled to 15% to 30% of what the Government gets back from the fraudsters.

Lee Wallace of The Wallace Law Firm, LLC is a trusted source for whistleblowers and other attorneys. She is a veteran Atlanta Medicaid/Medicare attorney who has been named one of Georgia’s Super Lawyers® and the Top 100 Trial Lawyers. Accepting cases nationwide, she has a reputation for being an effective advocate for whistleblowers.

We are ready to schedule a FREE consultation to hear your case.

How Medical Providers Are Cheating

For obvious reasons Medicare, Medicaid and TRICARE will not pay for medical treatments that a patient doesn’t need, and they won’t reimburse a company that gives the patient durable medical equipment (DME) that is unnecessary.

Unscrupulous medical and DME providers are trying several routes to get around the rule:

  • Some doctors go so far as to diagnose patients with diseases that they do not really have.
  • Some home health agencies, nursing homes, and other medical providers fake documents to make it look like a doctor has diagnosed an illness, or said that a piece of durable medical equipment like a wheelchair is needed. In reality, the medical provider fabricated the illness or the need — no doctor actually made the diagnosis.
  • Some home health agencies and hospice centers work provide doctors with stacks of paper about patients they have never seen, and ask the doctors to rubber stamp the treatment that the agencies or the hospice would like to give — and get paid for.

Do you know a doctor, hospital or DME that is billing Medicare for treatments that are medically unnecessary? It is important that you help the government stop fraud by blowing the whistle on a medical provider that is charging Medicare and Medicaid for medically unnecessary treatments, drugs or durable medical equipment.

Real Cases Involving Medically Unnecessary Services Billing

Medically Unnecessary Medical Treatments:

  • In May 2014, the Department of Justice settled a False Claims Act lawsuit with Baptist Health System Inc. of Jacksonville, Florida. The company paid $2.5 million in a False Claims Act case filed by a whistleblower. The whistleblower that two neurologists who worked for the Baptist Health group diagnosed patients as having neurological disorders, even multiple sclerosis, and then proceeded to treat the patients — and bill Medicare, Medicaid and TRICARE — for drugs and treatments for illnesses the patients never had. A former Baptist Health employee filed a False Claims Act lawsuit as a whistleblower, saying that the patients had been misdiagnosed and did not have the disorders for which they were being treated. The whistleblower received $424,155 for her role in stopping the fraud.

Medically Unnecessary Durable Medical Equipment:

  • Two men were sentenced to six and four years, respectively, for their role in a durable medical equipment (DME) fraud scheme. Using a DME company called Spectrum Foundation, Inc., the two men submitted $4.4 million worth of false and fraudulent claims for medical equipment, according to a 2013 DOJ press release, Former Durable Medical Equipment Company Owner Sentenced for Defrauding Medicare. The company was accused of falsifying documents to make it look like equipment was medically necessary and had been prescribed by a physician. In reality, DOJ said, the two men paid recruiters for names of Medicare beneficiaries, and then created paperwork and patient medical records in order to trick Medicare into paying claims for wheelchairs, Artho kits and other medical equipment that were not medically necessary. The men also were accused of upcoding, billing Medicare for equipment for beneficiaries who already had died, and in some instances failing to deliver equipment at all.

To find out more about being a whistleblower when a medical or DME provider is charging for unnecessary medical treatments and equipment, contact The Wallace Law Firm today. We work hard to make sure that we hold the perpetrators responsible for their misconduct and fraudulent behavior.

Questions? Ask our attorney about your fraud case.