The healthcare industry is big business in America. It also receives a significant amount of government spending. Medicaid, for example, results in over $400 billion a year in benefits. Medicare adds another $600 billion. Total spending on healthcare in the United States amounts to about 17% of our total Gross Domestic Product (GDP) at about $2.7 trillion. With so much at stake, it is no wonder the industry is fraught w...
For every $100 we spend on healthcare in the United States, as much as $10 is lost completely. It doesn’t go toward a sick grandmother who depends on Medicare. It doesn’t go toward the poverty-stricken family in need of funds to pay for a sick family member. It doesn’t even go to the less emotionally appealing aspects of our healthcare system, like document processing or claims management. That $10 is simply gone. Whe...
The federal False Claims Act (FCA) and related qui tam legal actions, as you can see from the size of the settlement, is a powerful tool that can be used to discourage healthcare providers from defrauding government health programs. A successful case can also hold accountable those who engage in fraud and other illegal acts. Legal claims involving alleged billing for unnecessary hospital claims and illegal kickbacks to refe...
Sometimes it can feel as if fighting health care fraud is like bailing out a leaky boat with a thimble. But take heart: In August, 2018, three False Claims Act (FCA) health care settlements took place that might not have come to light if whistleblowers hadn’t been willing to get involved. Two cases involved physician kickbacks, and one concerned upcoding. When people blow the whistle, it benefits all of us. Are you thinki...

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