Types of Medicare Fraud and Medicaid Fraud
If you report upcoding fraud against Medicare, you may be entitled to a whistleblower reward, as outlined in this website. If you want former Justice Department Attorney Joel Hesch to evaluate in complete confidence to see if you have the right type of case to get a reward, then fill out the form at this link (click here) and Mr. Hesch will get back to you right away.
If you want to read more about the $1.75 billion in whistleblower reward cases Mr. Hesch has handled click here.
More details about Medicare upcoding fraud
Many hospitals and healthcare provides cheat Medicare or Medicaid by upcoding their bills. Medicare and Medicaid typically reimburse providers using a prospective payment system (PPS). For instance, if they use the code for bronchitis, they get paid a set amount of money regardless of how much the treatment cost. However, if they use the code for pneumonia, they get paid a higher PPS amount because it generally costs more to treat that condition. Under upcoding fraud, a hospital or healthcare provider creates a scheme where they decide to use a higher paying code to cheat and collect more money.
The government pays significant rewards for reporting upcoding fraud to whistleblowers who know of intentional schemes to purposefully upcode the condition or treatment provided to patients under the PPS system.
If you know of a healthcare provider cheating through Medicare or Medicaid through upcoding fraud and are interested in a reward, fill out our fraud questionnaire.