Types of Medicare Fraud and Medicaid Fraud
If you report unbundling fraud against Medicare, you may be entitled to a whistleblower reward, as outlined in this website. (Click here if you want Attorney Joel Hesch to review your claim in confidence.)
Many hospitals and healthcare provides cheat Medicare or Medicaid by unbundling their services. Medicare and Medicaid typically reimburse providers using a prospective payment system (PPS). For instance, if they perform an appendectomy, they receive a set price amounting to the average cost for that procedure regardless of how much the procedure actually cost. However, some hospitals and healthcare provides commit Medicare or Medicaid fraud by separating out the costs from the procedure to bill them separately because the total PPS payments for each separate task amounts to more money than the total procedure. It is like selling the government a car, but not charging the price of a new car, but charging the government the price you would pay if you bought each part of the care at an auto supply store, which would be double or triple the price you would pay to buy the car.
The government pays significant rewards for reporting unbundling fraud to whistleblowers who know of intentional schemes to purposefully billing Medicare or Medicaid for individual tasks that really are part of one larger procedure. If you know of a company cheating through Medicare or Medicaid through unbundling fraud and are interested in a reward, fill out our fraud questionnaire.