The American and Illinois healthcare systems have been popular targets of fraud for decades. When Chicago labs, hospitals, and other healthcare providers try to cheat by claiming more money from government-funded healthcare programs, it is everyday Illinois residents who pay the price.
If you have knowledge of healthcare fraud being committed by your employer or another entity that you have intimate knowledge of, contact our healthcare fraud lawyers in Chicago for a confidential legal consultation. You may be eligible for a financial reward for speaking up.
Why Do Chicago Healthcare Providers Commit Fraud?
Of all of the government systems that a company or individual could target to defraud, why healthcare? Unfortunately, the healthcare system is often targeted due to its profitability and the relative ease with which someone can falsify information about the care they are providing patients.
In the year 2018, Medicare alone accounted for 15 percent of federal spending. The benefits paid out in 2018 totaled $731 billion, a 58 percent increase from $462 billion in 2008. This number is expected to continue to increase as the qualifying population for Medicare (those over 65 years of age) increases. Medicaid, which is the government’s healthcare program for those under a certain income, is a large factor in the federal budget as well. In 2018, Medicaid accounted for 16 percent of federal spending.
With more than 3 million Illinois residents relying on Medicaid alone, it means there are multiple opportunities for fraud.
Common Examples of Chicago Healthcare Fraud
In order to help stop healthcare fraud, you need to know how to spot it. The majority of healthcare fraud involves falsifying documents when billing Medicare and Medicaid. Here are a few common practices when a healthcare practice or provider is committing healthcare fraud.
- Deliberate miscoding. Coding is an important tool that helps providers bill insurance or government programs accurately. Since healthcare is such a broad field with a wide variety of possible procedures, visits, exams, and more, each service has a universal alphanumeric code that is used to bill that service. Coding errors can and do happen, but some people deliberately change the codes to bill the government for a higher amount.
- Billing for services not performed. A medical office or practice may try to slip an extra service into their billing, even though the service was never performed. For example, if a practice sees a patient with kidney disease who is on Medicare, they may bill Medicare for dialysis even though that patient is not on dialysis. Since the treatment makes sense for the condition, the government may not question the charge.
- Changing details to receive a higher payout. Even for services that were performed, the healthcare provider may bill it in a way that does not represent how it was done. If a patient has surgery and their surgeon was a junior resident, the hospital could report that the chief of surgery performed the procedure instead, since their rate would be higher than that of the junior resident.
On their own, these actions may not indicate a fraud case, but together or on a consistent basis they may be a cause for concern.
Rewards for Whistleblowers Under the Federal and Illinois False Claims Acts
The federal False Claims Act is the primary law relating to whistleblowers throughout the United States. It was enacted in the 1800s, following high rates of contractor fraud during the Civil War, in order to encourage people with insider information about fraud to let the government know.
The False Claims Act is responsible for the prosecution of countless cases of fraud, and it is what protects and rewards whistleblowers for the information they provide. Whistleblowers who provide information that leads to a successful lawsuit may be entitled to a financial reward of 15-30 percent of whatever the government recovers, incentivizing people to come forward.
The Illinois False Claims Act is similar to the federal law but instead focused on fraud committed against the state government and its municipalities. Fraud committed against the Illinois Medicaid system falls under the Illinois False Claims Act. Like its federal counterpart, the state of Illinois rewards whistleblowers financially for reporting fraud.
Retaliation For Reporting Fraud: Should You Be Concerned?
The law states that whistleblowers are protected from retaliation after their disclosure to an expert qui tam lawyer like Tycko & Zavareei LLP. We will do everything in our power while we pursue your case to protect you, your identity, and your livelihood. In fact, the False Claims Act says that whistleblowers must hire a lawyer, largely for the purposes of identity protection. Employers should not be made aware of who blew the whistle on them.
Threats and intimidation can be a form of retaliation along with less subtle forms like demotion, pay cuts, transfers, and even termination. Preventing these actions against whistleblowers is part of what we do here as a top healthcare fraud whistleblower law firm.
Finding a Healthcare Fraud Lawyer in Chicago
Anyone, anywhere, can be a whistleblower. All it takes is insider knowledge and courage. Healthcare fraud whistleblowers in Chicago can count on Tycko & Zavareei LLP for help.
The first step is to bring any evidence you have—document copies, screenshots, receipts, audio recordings, etc.—to the lawyer and talk to them about whether or not your case could lead to a successful qui tam lawsuit in Chicago. They will review your case and evidence for free, and if they feel that it is solid, they will file a False Claims Act lawsuit on your behalf and the justice process will begin.
