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Widespread Fraud of Medicare A report by a whistleblower attorney

/ m/ Fo r many years the U.S. go vernment has urged do cto rs and ho spitals to get rid o f messy and so metime illegible hand-written patient histo ries in favo r o f electro nic reco rds. Pushing the benefits o f efficiency, accuracy and impro ved care, the go vernments campaign has been successfulbut no t witho ut creating a new way to co mmit fraud in the pro cess. The switch to electro nic reco rds has pro ven to be an easy target fo r widespread fraud o f Medicare, as well as o ther go vernment agencies. Acco rding to investigatio ns by media o utlets and go vernment audito rs, do cto rs and ho spitals are increasingly upco dingclicking o n the mo st co stly Medicare reimbursement co des, even when they have no t rendered the services to justify them. The switch to electro nic medical reco rds has made these kinds o f cheats po ssible system-wide and no t just in the reco rds fo r a single patient. In a co mmo n scenario , a do cto r selects a co de that tells Medicare the do cto r spent mo re time with a patient than actually o ccurred. In ano ther example, a chain o f urgent care facilities falsely bills fo r allergy and o ther diagno stic tests they never perfo rmed. There is also the related pro blem o f clo ning, a practice in which do cto rs cut and paste o ld reco rds to pad the mo st current visit and make it appear that mo re extensive treatment to o k place. Between 20 0 1 and 20 10 , Medicare reimbursement co sts so ared by $11 billio n, and there is little evidencesuch as a sicker and o lder po pulatio n requiring mo re acute careto acco unt fo r such a massive co st increase. Emergency ro o ms are so me o f the wo rst o ffenders o f billing co de fraud. Between 20 0 1 and 20 0 8 , emergency ro o ms natio nwide increased Medicare billing substantially, adding $1 billio n to the tab paid by taxpayers. In just o ne example, the number o f claims by emergency ro o ms fo r pro viding the two highest catego ries o f care jumped fro m 40 percent in 20 0 6 to 54 percent in 20 10 . These two catego ries also pro vide the highest reimbursements po ssible fro m Medicare. The go o d news is that health care emplo yees, including do cto rs, nurses, and administrato rs, have been helping expo se the fraud and return mo ney to taxpayers. These whistleblo wers are pro tected under the federal False Claims Act, which has led to the reco very o f mo re than $30 billio n in lo st go vernment funds since the law was o verhauled in 19 8 6 . By law, the whistleblo wer is also entitled to a po rtio n o f any damages reco vered. The False Claims Act and many state laws like it also pro vide emplo yees pro tectio n fro m retaliatio n fo r trying to expo se fraud o n the go vernment.

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o n the go vernment. Abo ut - Keller Gro ver whistleblo wer law firm Jeffrey F. Keller, a fo unding partner at Keller Gro ver, a natio nally reco gnized labo r and emplo yment law firm, says whistleblo wers can play an impo rtant ro le in fighting fraud o n the go vernment. To the average perso n, the co untrys financial wo es might seem almo st to o huge to co ntemplate. Its hard to kno w ho w to make a difference, Keller says. But whistleblo wers can play a crucial part by disclo sing the fraud that is fleecing o ur treasury every year. Whistleblo wers are co urageo us peo ple who sho uld be rewarded fo r their effo rts. If yo ur emplo yer is a Medicare co ntracto r with the go vernment and yo u kno w the co mpany has been engaged in electro nic medical reco rds fraud a whistleblo wer atto rney may be able to help. Co ntact the Keller Gro ver whistleblo wer law firm to day fo r a free, co nfidential case evaluatio n. Fo r mo re info rmatio n please visit http://www.kellergro verwhistleblo m/widespread-fraud-o fmedicare-a-repo rt-by-a-whistleblo wer-atto rney_9 137.html


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