How to report hospital fraud by billing inpatient status instead of observation status, report outpatient procedure fraud, or report same day discharges and readmission, and how to obtain a whistleblower reward

Reporting inpatient hospital fraud for billing for observation status, outpatient procedure fraud, or short stay fraud and same day discharge and readmission fraud

Some hospitals fraudulently bill Medicare Part A for in patient beneficiary stays that should have been billed as outpatient or outpatient with observation services. Hospitals also fraudulently bill Medicare for same day discharges and readmission as inpatient services.

This article shows you how to get a reward for reporting Medicare/Medicaid fraud by hospitals billing for inpatient services that are really short stays, observation status, outpatient procedures, or same day discharges and readmission.

Report Medicare Fraud by hospitals billing short stays as inpatient services or observation status as inpatient services

It is Medicare fraud for a hospital to bill inpatient admission status of patients when they were really observation or outpatient status. It is improper for doctors or coding clerks to make decision to bill Medicare as “inpatient” based upon the amount of money Medicare pays for inpatient status versus observation status or outpatient treatment. Hospitals are required to verify the medical records to support determinations by doctors who admit patients to the hospital as “inpatient” status and ensure that they are not billing short stays or observation status as inpatient status.

Report Medicare Fraud by hospitals billing outpatient procedures as inpatient services

It is Medicare fraud for a hospital to bill inpatient status for outpatient procedures. Medicare pays more for inpatient medical treatment or services than for outpatient treatment. Recently one hospital agreed to repay $26 million to settle allegations that it falsely billed Medicare for inpatient admissions that were actually outpatient visits.

Report Medicare Fraud by hospitals billing same day discharges and readmission as inpatient services

Some hospitals engage in the fraudulent practices of billing Medicare separately for related discharges and readmissions within the same day. For instance, if a patient returns to the hospital on the same day relating to the same symptoms or same acute care, the hospital must not bill for two separate treatments, but must combine both into one bill. It is Medicare fraud to bill inpatient same-day discharges and readmissions in two bills instead of just once.

Needless to say, the amount of the Medicare bill is significantly higher if the hospital bills twice for the same condition as if it bills for all the treatment occurring in a single day.

Tips for reporting inpatient hospital fraud

To properly report fraudulent schemes of billing Medicare or other healthcare programs for inpatient status when they were either outpatient; observation; or same day treatment, and to be eligible for a whistleblower reward you cannot simply call a Medicare fraud hotline. Rather, to apply for a reward for reporting the fraud you must use an attorney (on a contingency basis) to file qui tam suit under the False Claims Act. Your attorney must follow the exact procedures of the whistleblower reward statute to get a reward for reporting fraudulent billing of inpatient status.

In addition, you need to report in detail how hospital is engaged in a fraudulent scheme to cheat Medicare by improperly billing inpatient status. The government needs your help in uncovering fraudulent billing of inpatient status by hospitals. But, because most whistleblower reward applications lack specific proof or contain other defects, the government turns away 75% of reward claims. That’s why selecting an experienced attorney that has handled Medicare fraud cases is important.

How much reward for reporting a hospital improperly billing of inpatient status?

The amount of a whistleblower reward for reporting fraudulent billing of inpatient status is based upon the amount of money the government recovers back, and the reward is between 15% and 25% of what the government collects back from the hospital cheating Medicare by billing for inpatient status. In the example above where a hospital repaid $26 million, the amount of a whistleblower reward could be between $3.9 million and $6.5 million.

How to report a hospital falsely billing inpatient status

This website (and the books authored by Mr. Hesch) walk you step-by-step through the entire process of reporting a hospital falsely billing inpatient status and fraud against Medicare, and shows you how to obtain a whistleblower reward.

Mr. Hesch has considerable experience with investigating Medicare fraud against the federal government while working for 15 years at the Civil Fraud Section of the U.S. Department of Justice in Washington, D.C., which is the office with nationwide authority over the whistleblower reward program. He now represents whistleblowers and confidentially reviews information to determine whether and how to report fraud against Medicare by a hospital falsely billing inpatient status.

The link below “Do I have a case” shows you how to ask Mr. Hesch to review your allegations that a hospital fraudulently billed Medicare for in patient beneficiary stays that should have been billed as outpatient or outpatient with observation services or other forms of inpatient fraudulent billing schemes.