Private Citizens Can Fight Health Care Fraud

With unscrupulous health care providers cheating Medicare and Medicaid across the country and helping to create a serious financial problem for the U.S. government that affects all of us, stepped up enforcement of laws covering this type of crime is badly needed.

In addition to more vigilance from law enforcement, involvement from private citizens is also necessary to help stem this nationwide epidemic.

One way to get involved is to blow the whistle on health care fraud when you see it or suspect it. Having said that, please don’t use this to settle a personal score or to take revenge on your boss for not giving you the raise you wanted.

Whistle-blower provisions

If indeed your suspicions involve true health care fraud, private citizens can file suit under the qui tam, or whistle-blower provisions of the False Claims Act.

It’s possible that the whistle blower would earn a share of any financial recovery made.

A good example of such a situation recently occurred in Georgia. A dentist there was accused of violating the False Claims Act in at least two ways.

First of all, he is accused of doing something called “upcoding,” which happens when a provider seeks payment from a government program for higher and more expensive levels of service than what was actually performed.

Unsupervised dental assistant

Second, the dentist allegedly billed Medicaid for services that were provided by an unsupervised dental assistant on days in which the dentist was not even in the office. It is against the law for assistants to provide care without the direct supervision of a licensed dentist.

A civil settlement was reached in that case for more than $300,000. There were also criminal charges for which the dentist was given a year of probation and lost his license to practice dentistry.

A private citizen had brought a lawsuit against the dentist. She will receive a share of the settlement payment.

In closing, let’s keep in mind that there are ways for all of us to help stop this enormous drain on the U.S. treasury. Let’s give law enforcement a hand by keeping our eyes and ears open and getting involved.

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