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May 12, 2014 by |

Healthcare Fraud Whistleblower Lawsuits Plentiful


The government funds healthcare through Medicare and Medicaid. There are an abundance of whistleblower lawsuits filed that are related to the healthcare industry. The role of the government in funding part of the healthcare system has led directly to the large number of whistleblower or False Claims lawsuits. Hospitals, doctors, makers of durable medical equipment, and pharmaceutical companies are the targets of most of the whistleblower lawsuits relating to the healthcare industry. In the past twenty years approximately 70% of the money recovered by the government in False Claims Act actions has been in cases relating to healthcare fraud. California whistleblower attorneys are glad that healthcare fraud is being exposed.

One type of healthcare fraud is upcoding. When a hospital or other health service provider provides a service to a patient, but uses a more expensive billing code when billing for the service upcoding has occurred. Another related type of fraud is called unbundling. This happens when groups of related services should be billed under a single code, but are instead billed separately so that reimbursement is higher. Healthcare fraud associated with billing persists as a problem in many healthcare institutions. California whistleblower attorneys want the public to be aware of various types of billing fraud.

When a doctor or hospital is given money or other financial motivation in exchange for referrals or prescribing certain medications, a kickback has taken place. There are a variety of laws that prohibit this practice. The laws are intended to make sure that doctors prescribe medications based on the needs of the patient.

Another type of fraud in the healthcare industry is off-label marketing. This happens when pharmaceutical products or medical devices are promoted for uses that have not been approved by the Food and Drug Administration. US regulations state that reimbursement for pharmaceutical products or medical devices is permitted only for uses approved by the Food and Drug Administration. Thus, off-label marketing leads to the submission of false claims to the Medicare and Medicaid systems. California whistleblower attorneys say that off-label marketing is problematic.

The falsification of medical records is another type of fraud that is common. Medicare and Medicaid reimburse providers for services only if the service is medically necessary. Healthcare institutions are required to maintain records to prove medical necessity. If a healthcare provider falsifies or fails to keep the records then the provider could be committing healthcare fraud when it submits bills for the services.

Evans Law Firm, Inc. handles whistleblower/false claims, consumer fraud class actions, insurance and banking fraud, consumer product liability, elder abuse, and personal injury cases. If you think that you have witnessed or are the victim of financial fraud by an insurance company, bank or individual then, contact Evans Law Firm, Inc. at (415) 441-8669 for a free and confidential consultation, or email

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