Nursing is considered the most honest and ethical profession in America for fifteen years running, according to the annual Gallop report. With that understanding, it should come as no surprise that nurses are more likely to report healthcare fraud than any other provider in the field. Being on the front line of patient care often means that the nurse bears direct witness to Medicare fraud, waste and abuse – as well as its consequent effects on patients. All too often, the schemes negatively impact their patient’s emotional and physical well-being, and can further result in devastating financial hardships.
America spends a whopping $2.7 trillion dollars on healthcare, or 17% of our GDP. It is estimated that over $270 billion of this is reimbursed as a result of Medicare and Medicaid fraud; this burden trickles down to the taxpayer, who feel the strain each year when taxes are raised to cover these inconceivable losses.
When a nurse uncovers fraud, it can be overwhelming, frustrating and heartbreaking. The first course of action most frequently taken involves the nurse bringing forward information to his or her superiors, in an attempt to rectify the unscrupulous behavior; however, all too often, this results in negative consequences or outright disregard for the information brought forward. When this happens, a nurse may seek outside help to ensure her patients are protected and the moral structure of the healthcare system is upheld.
Thankfully, there are numerous whistleblower protections in place that ensure nurses who report healthcare fraud are safe from employer retaliation. Deciding to blow the whistle is a brave act, but not one to be taken lightly. Whistleblower Justice Network has worked with countless nurses to help them understand their options to protect both their patients and themselves. When whistleblowing was the right path, Whistleblower Justice Network has helped those nurses to build successful cases while guiding them through the complexities of their whistleblower journey.
The most rampant examples of healthcare fraud include:
- Billing for services not provided
- Upcoding; the practice of inaccurate billing to increase reimbursement.
- Deceptive coding to get paid for services not covered by insurance
- Kickbacks and Bribery
- Lack of medical necessity for procedures or services
- Over-utilization of services, beyond what is deemed necessary
- Incorrect reporting of diagnoses or procedures
- Bundling or Unbundling procedures (grouping procedures to qualify for special reimbursement rates; or unbundling procedures to get paid for each separately to increase reimbursement rate)
- Misrepresenting location, dates or providers of a service.
- Waiving co-payments or deductibles.
- False or unnecessary issuance of prescription drugs.
Whistleblower Justice Network Can Help You
Our case analysts help whistleblowers fully understand, organize and refine the information that they have in their possession. Complemented by our understanding of a wide array of Medicare and Medicaid fraud, Whistleblower Justice Network will help you make your best case, determine the most appropriate whistleblower attorney to handle your case, and ensure that your case receives the attention it deserves every step of the way.
Contact us today and let us explain how we work with whistleblowers in pursuit of justice against those who defraud the healthcare system, the U.S. government, and each of us as its citizens. Working with whistleblowers, and filing whistleblower actions is all we do as a company. We are whistleblowers ourselves, and we love what we do. Our clients and Whistleblower Justice Network, together we make a difference.