Steps You Should Take If You Become A Victim Of Medical Fraud

Most medical providers or healthcare professionals are passionate, honest, hardworking, and prioritize quality patient care. However, there are a few who are crooked and involved in ill medical practices to gain profits that compromise their patients’ records and well-being, resulting in healthcare fraud. 

In this post, you’ll learn the steps you should take if you’ve become a victim of healthcare fraud. 

Know What Constitutes Medical Fraud 

Medical fraud is like fraud committed in any other industry, wherein fraudsters take full advantage of their patients and their position to unjustly profit. It involves manipulating information and misleading claims. 

Healthcare crooks may include healthcare providers, vendors, suppliers, employers, payers, and even patients. Organized crime and cybercriminals also commit medical fraud. 

For instance, an insurance claim would indicate “Provided Group Therapy,” but the psychiatric patients were just left unsupervised in a small room watching a movie. This simple example already constitutes medical fraud, which is deliberately stating false information on the insurance claim just to get money out of it.

Here are other examples of medical fraud:

• Billing for healthcare services not provided
• Misrepresenting dates of healthcare service
• Misrepresenting locations of healthcare service.
• Incorrect reporting of procedures or diagnoses 
• Corruption, like bribery and kickback
• Unnecessary or false issuance of prescription drugs

Many victims of medical fraud are concerned about how Medicare fraud whistleblowers are protected. Consulting a healthcare fraud lawyer can help you ensure that your case is evaluated for proper reporting and keep you safe and protected by keeping your identity confidential.

Identify the Payor of the Bill

There are different ways to report suspected medical fraud. You can start by identifying the payor of the bill, such as Medicare or private insurance, Medicaid. Private insurance companies usually have their own fraud reporting mechanism.

Generally, all Medicaid issues are reported to the state controlling Medicaid spending dollars. Also, each state attorney general’s office or department of health and human services has ways of reporting Medicaid fraud.

For suspected abuse of the federal insurance program or Medicare, medical fraud should be reported to the country’s Department of Health and Human Services Office of Inspector General (HHS-OIG). Also, the FBI has dedicated teams that investigate medical fraud and have dedicated phone lines for reporting fraud and abuse.

Determine Where to Report Medical Fraud 

Once you’ve determined the payor, it’s time to know where to report the medical fraud. The HHS-OIG of the state you live in reviews and investigates a lot of complaints each year. You can submit an online complaint, call, or mail your complaint. 

The HHS-OIG investigates whistleblower complaints, such as HHS programs mismanagement and abuse, waste, and fraud relating to contracts or HHS grants. Also, the agency investigates fraudulent or false claims submitted to Medicaid or Medicare, including inducements or kickbacks for referrals by medical providers. Medical identity theft that involves Medicare or Medicaid beneficiaries, neglect or abuse in nursing homes, and failure to evaluate an emergency patient is also investigated.

If you or your loved one has become a victim of health care fraud, you should prepare yourself for healthcare fraud litigation early on by consulting a lawyer. 

Know How to Report Medical Fraud 

There are many ways to report medical fraud. You can submit a complaint online, call or fax HHS-OIG, or mail your complaint. 

Because medical fraud is usually organized and involved multi-million pharmaceutical companies and hospitals, whistleblowers should be protected. That’s why, as much as possible, consult a lawyer who’s an expert on this field should be done before submitting a complaint.

Here are important things to remember when reporting medical fraud:

• Mail-In Complaint: If you file your complaint via snail mail, include a photocopy of the documents to support your allegation. Don’t send original documents to HHIS-OIG because they won’t be returned. Don’t mail digital media (disks, flash drives, iPads), used medical supplies, medical waste (sharps like needles or lances), used personal care products, clinical specimens, or biological products to HHS-OIG.
• Fax or Facsimile Complaint: The HHS-OIG Hotline requires medical fraud complaint the use of the complaint submission form, which is downloadable and available in DOCX or PDF versions, or to include a formal cover letter.  OIG Hotline Operations doesn’t accept facsimile submissions with more than 45 pages because such submissions are only allowed online – where uploading of larger documents is possible.

Conclusion

If you’ve become a victim of medical fraud, you should take the right steps to keep your identity protected as much as possible. Knowing what constitutes healthcare fraud, where to report it, and how to report it is important. 

Also, don’t overlook consulting a medical fraud whistleblower lawyer to help you go through the healthcare fraud assessment and reporting process. This is to ensure that you’re doing the right thing and keep you protected.